Conservative management of 900 pediatric distal radius fractures using the schede cast: a multicenter study

BACKGROUND: Distal forearm fractures are among the most common pediatric injuries and are typically managed with cast immobilization. Volar-flexion ulnar-deviation splints (Schede casts) have been proposed to reduce displacement and prevent secondary dislocation. However, data on efficacy and safety in children remain limited. This study aimed to evaluate the clinical outcomes of Schede cast immobilization across four pediatric trauma centres over a 16-year period. METHODS: We conducted a retrospective analysis of patients under 18 years with distal forearm fractures treated with Schede casts. Demographic data, fracture characteristics, initial and post-cast displacement, incidence of secondary dislocation, and complications were recorded and analyzed. RESULTS: A total of 900 patients (mean age 9.47 years) were included. The most common mechanism of injury was sports-related trauma, and transverse metaphyseal fractures predominated. Mean initial displacement was 17.7° (± 9.4°), reduced to 5.9° (± 5.5°) after cast application and 6.9° (± 5.4°) at consolidation after a mean of 35 (± 16) days. Secondary dislocations were effectively prevented at flexion angles > 50° (p < 0.001). Complications were rare: tingling paresthesia occurred in 22 patients (2.4%), and prolonged movement restriction in 8 patients (0.9%). All adverse events resolved within days to weeks without long-term sequelae. CONCLUSION: Schede cast immobilization is a simple, safe, and effective method for retaining distal radius fractures in children. It reliably prevents secondary dislocation while maintaining low complication rates, supporting its continued use in pediatric trauma care.