Intraoperative wedging of casts: correction of residual angulation after manipulation

Seventy children, aged 2-14 years, had a manipulation under anaesthetic (MUA) of a forearm or lower leg fracture, in which the MUA failed to fully correct the deformity in 16. An opening wedge (WEDGE) was performed while still under the original anaesthetic in one group and compared to a parallel but uncontrolled group using the traditional regimen of remanipulation (RE-MUA). There was an observed reduction in the average time under anaesthetic comparing WEDGE to RE-MUA in the forearms (34 vs. 46 min) and in the legs (42 vs. 61 min). There was no obvious difference between the proportion of those needing "further adjustments" (defined as wedging at outpatients or a further MUA) if the fracture displaced comparing WEDGING (zero of six) to RE-MUA (one of 10), and there was also no obvious increased time to union. At review, there was < 10 degrees malunion in any plane, which should not predispose to restricted forearm rotation or chronic ligamentous strain/joint degeneration in the leg.