Short and long arm cast and pain after discharge in children who underwent reduction of distal forearm fracture in the Emergency Department: A study protocol for a randomized comparative effectiveness study

Abstract

Distal forearm fracture is the most common fracture in childhood. Patients with this type of injury suffer from meaningful pain after Emergency Department (ED) discharge. Previous studies demonstrated that short arm (below-the-elbow) casts perform as well as long arm (above-the-elbow) casts for maintaining the reduction of distal forearm fractures, with a similar rate of complications. Consequently, short casts are the commonly used method of immobilization after closed reduction of a distal forearm fractures in children older than 4 years. However, short casts carry a potential disadvantage; since they cannot prevent supination in a wrist that is held in pronation, and vice versa, their use might be associated with pain.We initiated this study to examine the effect of the type of casting on post discharge pain. We will conduct an open-label randomized, controlled trial comparing short cast immobilization with long cast immobilization in children who had a reduction of distal forearm fracture in the ED. Our hypothesis is that children with distal forearm fractures who are treated with a long cast, experience less pain during the first 48 h after ED discharge than children who are treated with a short cast.

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

“…However, in children under the age of 4 years, an above-elbow cast is still recommended as short arm casts may slip. 11,12 In our institution, patients with distal forearm fractures who are older than 4 years, a short arm (below elbow) cast is applied, while patients younger than 4 years are treated with a long arm (above elbow) cast. According to department protocol, children with displaced forearm fractures are treated with closed reduction performed by the orthopedic surgeon.…”

Forearm fractures in Zagreb children

“…Napisano je dosta radova o operativ nom liječenju (standard je intramedularna elastična stabilna osteosinteza), kao i o neoperativnome (imobi lizacija i mirovanje). 5,6 No, malo je radova koji analizi raju uzroke nastanka tih ozljeda i daju preporuke o njihovoj prevenciji. Mlade države poput Republike Hrvatske nemaju vlastitih spoznaja o učestalosti uzro ka mnogih pojava, pa tako i ozljeda u djece.…”

Çocuklarda radius başı ve olekranon kırıkları

“…Ayrıca, redüksiyon ve alçı immobilizasyonu sonrası ağrının en fazla olduğu ilk 48-72 saat, uzun kol alçı uygulanan hastalarda analjezik ihtiyacının daha az olduğu gösterilmiştir. [17] Kısa kol alçıyı savunanlar, çocukların okuldan daha az geri…”