Waterproof Casts Maintain Reduction and Decrease Unplanned Cast Changes.

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Biomaterials in medicine

Background:

• Pediatric fractures are common, with casting being a primary treatment method.
• Standard casts utilize cotton liners, which can be prone to moisture retention and associated complications.
• Waterproof casting technology offers a potential improvement in patient care and outcomes.

Purpose of the Study:

• To compare the clinical outcomes of waterproof versus standard casting in pediatric patients with nonoperative upper and lower extremity fractures.
• To evaluate the efficacy of waterproof casts in maintaining fracture reduction and minimizing complications.
• To assess the impact of waterproof casting on casting duration and the frequency of cast changes.

Main Methods:

• Retrospective review of 516 pediatric patients treated with casts for nonoperative extremity fractures.
• Casts categorized by liner material (waterproof vs. standard cotton).
• Primary outcomes: cast changes, casting duration, complication rates. Secondary outcomes: in-cast displacement, casting failure, need for reduction or surgery. Subgroup analysis of displaced forearm fractures.

Main Results:

• Waterproof casts showed significantly fewer total cast changes (9.9% vs. 39.8%) and shorter mean casting duration (27.0 vs. 29.5 days).
• In-cast displacement occurred less frequently with waterproof casts (16.3% vs. 24.4%).
• No significant differences in fracture angulation, translation, casting failure, repeat reduction, or surgical intervention between groups.

Conclusions:

• Waterproof casts are associated with reduced unplanned cast changes and shorter casting duration compared to standard casts.
• Waterproof and standard casts are equally effective in maintaining reduction of displaced pediatric forearm fractures.
• Waterproof casting is a safe and convenient alternative for pediatric fractures, potentially improving patient comfort and reducing care burden.