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Pain during Cast Wedging of Forearm Shaft and Distal Forearm Fractures in Children Aged 3 to 12 Years-A Prospective,
Florian Freislederer1, Tobias Berberich2, Thomas O Erb3
1Department of Pediatric Surgery, University Children's Hospital Basel (UKBB), 4031 Basel, Switzerland.
Insights
Cast wedging effectively corrects forearm fractures in children with minimal, short-term pain. This procedure offers a safe and effective treatment option for pediatric fracture displacement.
Area of Science:
- Pediatric Orthopedics
- Pediatric Fracture Management
Background:
- Cast wedging is a common treatment for pediatric fracture displacement.
- Limited data exists on the pain experienced by children during cast wedging.
Purpose of the Study:
- To evaluate the pain associated with cast wedging in children aged 3-12 years.
- To determine if there is a clinically significant difference in pain before and after the procedure.
Main Methods:
- Prospective observational study of 68 children (3-12 years) with forearm fractures.
- Pain assessed using Visual Analog Scale (VAS) before and after cast wedging.
- Analgesia included oral sodium metamizole and nitrous oxide/oxygen inhalation.
Main Results:
- Median VAS score increased slightly from 0 to 1 immediately post-procedure (p=0.015), with maximum remembered pain returning to 0.
- Significant improvement in fracture fragment alignment was observed in both anteroposterior (0°) and lateral (8.4°) views (p<0.0001).
Conclusions:
- Cast wedging is an effective method for improving pediatric forearm fracture alignment.
- The procedure is associated with minimal and transient pain, supporting its clinical utility.
Background:
Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age.
Patients And Methods:
This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days.
Results:
Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to 5 min after the procedure. Median VAS score for the maximum remembered pain measured after 30 min was 0. Median differences in angulation between proximal and distal bone fragments before and after the intervention were 0° (p < 0.0001) in the a.p. view and 8.4° (p < 0.0001) in the lateral view.
Conclusion:
Cast wedging improved the position of forearm fracture fragments at the expense of minimal short-term pain.
