Below-elbow cast sufficient for treatment of minimally displaced metaphyseal both-bone fractures of the distal forearm in children: long-term results of a randomized controlled multicenter trial

Abstract

Background and purpose — We have previously shown that children with minimally displaced metaphyseal both-bone forearm fractures, who were treated with a below-elbow cast (BEC) instead of an above-elbow cast (AEC), experienced more comfort, less interference in daily activities, and similar functional outcomes at 7 months’ follow-up (FU). This study evaluates outcomes at 7 years’ follow-up. Patients and methods — A secondary analysis was performed of the 7 years’ follow-up data from our RCT. Primary outcome was loss of forearm rotation compared with the contralateral forearm. Secondary outcomes were patient-reported outcome measures (PROMs) consisting of the ABILHAND-kids and the DASH questionnaire, grip strength, radiological assessment, and cosmetic appearance. Results — The mean length of FU was 7.3 years (5.9–8.7). Of the initial 66 children who were included in the RCT, 51 children were evaluated at long-term FU. Loss of forearm rotation and secondary outcomes were similar in the 2 treatment groups. Interpretation — We suggest that children with minimally displaced metaphyseal both-bone forearm fractures should be treated with a below-elbow cast.

Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials

“… 8 , 9 , 14 – 19 , 24 One publication reported the long-term follow-up of the same study as the original RCT. 25 The kappa statistics for interobserver agreement on study eligibility was 1.0. The detailed selection process (PRISMA diagram) is shown in Figure 1 .…”

“…The long-term study of Colaris et al 14 described no statistically significant differences between both groups at 7-year follow-up. 25 Re-manipulation was performed with varying reported rates between the studies. Indications for re-manipulation after loss of fracture reduction were not clearly reported in all studies.…”

“…The long-term study of Colaris et al 14 described no statistically significant differences between both groups at 7-year follow-up. 25 …”

Health-Related Quality of Life after Fractures of the Distal Forearm in Children and Adolescents—Results from a Center in Switzerland in 432 Patients

“…Unfortunately, we were no able to find many other studies assessing outcome measures such as the Quick-DASH or the Peds-QL in patients who had undergone a fracture of the distal radius or forearm. Musters et al reported DASH scores for 51 children who underwent either above or below elbow cast for mainly greenstick fractures of the distal forearm and reported DASH scores of 2.1 and 4.4. for these groups [ 18 ]. Peterlein et al [ 19 ] reported a remarkably good mean DASH score of 0.4 in 90 patients who had undergone elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in childhood fractures.…”

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years

“…However, the questionnaires were sent right at the beginning of the COVID pandemic (March 2020) in order to exclude the impact of this potentially influential event and therefore analyzed quality of life before the year 2021. Both questionnaires are widely used and validated for childhood [17][18][19][20][21][22]. The data from the returned questionnaires were collected pseudonymously and the data were analyzed in terms of fracture type and technique used for the individual patient.…”