Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized contr
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ORIGINAL PAPER
Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial Michelle Seiler 1,2 & Peter Heinz 2,3 Christoph Aufdenblatten 2,3
&
Alessia Callegari 1,2
&
Thomas Dreher 2,3
&
Georg Staubli 1,2
&
Received: 30 January 2020 / Accepted: 4 September 2020 # The Author(s) 2020
Abstract Purpose The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients. Methods A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow. Results No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item “help needed with showering in the first days after trauma” (SAC 60%, LAC 87%, P = 0.001). Conclusion Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering. Trial registration NCT03297047, September 29, 2017 Keywords Short-arm cast . Long-arm cast . Fiberglass cast . Distal forearm fracture . Paediatrics . Closed reduction
Distal forearm fractures (DFFs) are the most common fractures in childhood, accounting for 40% of all fractures in children [1]. The gold-standard imaging technique to determine the fracture type, the degree of fracture angulation, and fracture displacement is projectional radiography in two planes [2]. Nonoperative management with closed reduction and splinting of displaced fractures is the treatment of choice when closed
* Michelle Seiler [email protected] 1
Pediatric Emergency Department, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
2
Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
3
Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
reduction leads to a stable reduction, whereas surgical treatment is generally necessary for unstable, open, and intra-articular fractur
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