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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Updated: Jul 27, 2025

Pseudofracture: An Acute Peripheral Tissue Trauma Model
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The Slipper Fracture: Revisited.

Carolina Alvarez1, Joshua Chen1, Nick I Pilla2

  • 1Orthopaedics, Penn State College of Medicine, Hershey, USA.

Cureus
|June 8, 2023
PubMed
Summary

Slipper fractures, often angulating in casts, are challenging pediatric radius fractures. Proper long arm casting with an adequate cast index and position is crucial for preventing displacement and ensuring optimal healing.

Keywords:
angulationfracturemetaphysisradiusslipper

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Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Fracture management

Background:

  • Slipper fractures, defined as distal radius fractures at the metadiaphyseal junction, have a history of poor outcomes due to casting angulation.
  • Optimal casting techniques, including cast type and position (pronation vs. supination), remain debated for managing these fractures.

Purpose of the Study:

  • To evaluate the treatment outcomes of pediatric slipper fractures managed non-operatively with casting.
  • To identify key factors influencing reduction loss and angulation in slipper fractures treated with casts.

Main Methods:

  • Retrospective review of 16 pediatric slipper fractures.
  • Analysis of electronic medical records and radiographs for patient demographics, cast characteristics (type, position, cast index), and fracture outcomes.
  • Data collected included body weight, cast index, loss of reduction, angulation, cast wedging, repeat reduction, surgery, and remodeling.

Main Results:

  • The average patient age was 8 years, with an average body weight of 30.4 kg.
  • Most fractures (94%) lost reduction and angulated significantly (average 26 degrees) despite initial casting, primarily with long arm casts.
  • A cast index < 0.8 was associated with no displacement; remodeling averaged 15 degrees by final follow-up.

Conclusions:

  • Slipper fractures are inherently difficult to manage due to a high propensity for in-cast angulation and loss of reduction.
  • Appropriate application of a long arm cast, maintaining a suitable cast index, and correct cast positioning are essential for successful treatment.