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Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized
Michelle Seiler1,2, Peter Heinz3,4, Alessia Callegari5,3
1Pediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. michelle.seiler@kispi.uzh.ch.
Insights
Short-arm casts (SAC) offer comparable fracture stabilization to long-arm casts (LAC) for pediatric distal forearm fractures. SAC treatment also reduced the need for assistance with showering.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Distal forearm fractures are common in children.
- Traditional treatment involves long-arm cast (LAC) immobilization.
- The efficacy of short-arm cast (SAC) immobilization is less understood.
Purpose of the Study:
- To compare the fracture stabilization effectiveness of SAC versus LAC in pediatric distal forearm fractures.
- To evaluate secondary outcomes including pain management, daily activity restriction, and range of motion recovery.
Main Methods:
- Prospective, randomized controlled trial involving 120 children (4-16 years old).
- Patients were randomized to receive either SAC or LAC after closed reduction.
- Primary outcome: fracture stability and loss of reduction; Secondary outcomes: analgesic duration, activity restriction, elbow range of motion.
Main Results:
- No significant differences in loss of reduction or analgesic therapy duration between SAC and LAC groups.
- Significantly longer duration to regain normal elbow range of motion in the LAC group (P < 0.001).
- Reduced need for showering assistance in the SAC group (60% vs. 87%, P = 0.001).
Conclusions:
- Short-arm cast immobilization is non-inferior to long-arm casts for reduced distal forearm fractures in children (excluding completely displaced fractures).
- Short-arm casting improves functional independence, specifically reducing the need for help with showering.
Purpose:
The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients.
Methods:
A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow.
Results:
No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item "help needed with showering in the first days after trauma" (SAC 60%, LAC 87%, P = 0.001).
Conclusion:
Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering.
Trial Registration:
NCT03297047, September 29, 2017.
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