Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial

Heinz, Peter; Callegari, Alessia; Dreher, Thomas; Staubli, Georg; Aufdenblatten, Christoph

doi:10.1007/s00264-020-04800-w

Cited by 4 publications

(12 citation statements)

References 18 publications

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“…In a prospective, randomized controlled trial of 59 children at aa average age of 9,9 years (between four and 16 years) with isolated distal radius fractures, 31 children are treated with short-arm fiberglass cast and 28 ones with long-arm cast after closed reduction in Switzerland (Seiler et al, 2021). No statistically reliable differences between both groups either in loss of reduction, nor in analgesic therapy duration are establioshed.…”

Section: Discussionmentioning

confidence: 99%

Distal Radius Fractures in Childhood - Our Five-Year Experience

Staykov¹,

Kolarov²

2022

IJMSR

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The most common fractures in children are those of the distal radius. There are relatively scanty publications devoted to this specific pathology in childhood. The timely diagnosis and proper treatment of the distal radius fractures are of undoubted significance. The purpose of the present communication is to share our recent practical experience with the management of the distal radius fractures in children. 2. Methodology. During the period between January 1, 2017 and December 31, 2021, 34 children at an average age of 10,85±3,00 years (between two and 17) with wrist joint injuries resulting in distal radius fractures were examined in the Clinic of Orthopedics and Traumatology, St. Anna Multiprofile Hospital of Varna. There were 21 boys at an average age of 11,43±3,39 years (between two and 17) and 13 girls at an average age of 9,92±2,38 years (between six and 12). Diagnosis was based on clinical and x-ray examinations. Therapeutic behavior included operative treatment, administration of analgesic means, immobilization, and, in some cases, subsequent rehabilitation. Surgery was accomplished under general anaesthesia in most cases. 3. Results. Mean age did not differ statistically reliably between both groups (t=1,524; p>0,05). The left radius fractures (13 in boys and 11 in girls) were statistically significantly more common than right radius ones (eight in boys and two in girls) (t=3,726; p<0,001). Most commonly, a closed reduction technique with or without internal fixation of the radius and ulna was made use of (in 15 boys and in seven girls) followed by reposition and fixation with one Kirschner wire (in one girl), with two Kirschner wires (in five boys and one girl), or with three ones (in five boys and two girls). An open reduction technique was applied in six boys and in six girls followed by reposition and fixation with one Kirschner wire (in one girl), with two Kirschner wires (in two boys and two girls), or with three ones (in two boys). It should be noted that internal fixation was not carried out in two boys and three girls. Control x-ray examination was performed in all the children. Cast immobilization for a period between 28 and 35 days, most often, for one month, was obligatorily done. Subsequently, Kirschner wires were removed in eight boys and in four girls. One complication was observed in a six-year old girl. It was caused by mechanical damage of the left wrist joint following the implantation of the internal orthopedic devices, i.e. three Kirschner wires. They were removed two months after the operation. Complete healing was achieved in all the children. 4. Conclusions. Based on these results of ours, the conclusion can be drawn that these surgical procedures along with the precise diagnosis and immobilization have proven to be safe and effective in the children with distal radius fractures. Obviously, modern strategies to successfully prevent the fractures in children should be developed.

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Section: Discussionmentioning

confidence: 99%

Distal Radius Fractures in Childhood - Our Five-Year Experience

Staykov¹,

Kolarov²

2022

IJMSR

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“…Sensitivity analysis was conducted with the exclusion of studies associated with high risk of bias. 15,17,19 Another sensitivity analysis was conducted to evaluate if excluding articles 9,14,16 with children elder than 12 years of age would affect the results on the basis that these studies had adolescent patients compared with other studies with children younger than 12 years of age. Egger's test with funnel plot was performed for our primary outcome, the risk of loss of fracture reduction.…”

Section: Discussionmentioning

confidence: 99%

“…Further sensitivity analysis with the exclusion of the studies with patients older than 12 years of age 9,14,16 revealed an overall RR of 0.86 (95% CI = 0.48, 1.54, p = 0.05, I 2 = 58%) for loss of fracture reduction in favor of BEC treatment, but this did not reach a statistical significance (p = 0.51). The other outcome results and overall RRs altered only minimally.…”

Section: Other Sensitivity Analysismentioning

confidence: 95%

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

Alzobi

Hantouly

Kenawey

et al. 2023

Journal of Children's Orthopaedics

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Objectives: Distal forearm fractures are the most common pediatric fractures. This study aimed to investigate the effectiveness of below-elbow cast treatment for displaced distal forearm fractures in children compared to above-elbow cast through meta-analysis of randomized controlled trials. Methods: Several databases from January 1, 2000 until October 1, 2021 were searched for randomized controlled trials that assessed below versus above-elbow cast treatment of displaced distal forearm fractures in pediatric patients. The main meta-analysis comparison was based on the relative risk of loss of fracture reduction between children undergoing below versus above-elbow cast treatment. Other outcome measures including re-manipulation and cast-related complications were also investigated. Results: Nine studies were eligible of the 156 articles identified, with a total of 1049 children. Analysis was undertaken for all included studies with a sensitivity analysis conducted for studies with high quality. In the sensitivity analysis, the relative risks of loss of fracture reduction (relative risk = 0.6, 95% confidence interval = 0.38, 0.96) and re-manipulation (relative risk = 0.3, 95% confidence interval = 0.19, 0.48) between the below and above-elbow cast groups were in favor of below-elbow cast and statistically significant. Cast-related complications were in favor of below-elbow cast but did not attain statistical significance (relative risk = 0.45, 95% confidence interval = 0.05, 3.99). Loss of fracture reduction was noted in 28.9% of patients treated with above-elbow cast and 21.5% in below-elbow cast. Re-manipulation was attempted in 48.1% versus 53.8% of children who lost fracture reduction in the below-elbow cast and above-elbow cast groups, respectively. Conclusion: Below-elbow cast treatment was favored, with statistical significance, in terms of loss of fracture reduction and re-manipulation, and was not associated with a higher risk of cast-related complications. The accumulative evidence currently does not support above-elbow cast treatment and below-elbow cast treatment should be the mainstay for displaced distal forearm fractures in children. Level of evidence: Level I, meta-analysis of therapeutic level I studies.

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“…In a recent study, children with distal forearm fractures managed with short-arm casts required less assistance with showering when compared with those with long-arm casts (and fracture healing was not inferior). 20 Clinicians should understand the burden of immobilization and, for distal forearm fractures, consider a splint or below-elbow cast to optimize function. Help ensure that caregivers are prepared to provide assistance, even for tasks that the child could previously accomplish independently.…”

Section: ) Anticipate and Treat Painmentioning

confidence: 99%

Parental Perspectives on Children's Functional Experiences After Limb Fracture

Golden-Plotnik

Ali

Moir³

et al. 2021

Pediatr Emer Care

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Background: Fractures are a common childhood injury. Although the pain associated with fractures is well described, the related functional impact is less understood. When a child's function is impaired, his or her ability to participate in day-to-day life is restricted. Eighty percent of children with fractures experience compromise in daily function. An in-depth understanding of function can guide emergency department (ED) providers' discharge instructions.Objectives: Our aim was to report caregivers' perspectives of the functional impact of limb fractures on their children's day-to-day life activities. Methods:We performed a qualitative study using interviews of caregivers of children (aged 5 to 11 years) who received care for acute, nonoperative long bone fractures in a pediatric ED. Audio-recorded, semistructured telephone interviews were completed 7 to 14 days after the ED visit. Interviews were primarily open ended, including questions targeting areas of function from existing pediatric fracture literature. Qualitative analysis was completed using content analysis.Results: Twenty-five interviews were included in the final analysis. Most of the children were diagnosed with upper extremity fractures, and most participants were mothers. All parents reported a change in their child's function. The most commonly affected areas were sleep, activities of daily living, and play. Play was either self-limited by the child or restricted by the parent. Pain was worse in the first days after discharge. Many children struggled emotionally with functional limitations. All children required help from their parents to perform daily tasks; this required adaptive strategies such as planning, changes to household routine, and missed work. Key concerns from parents included regression in the child's independence and fracture healing and complications.Conclusions: Function is universally impaired in young children with fractures, significantly affecting family life after discharge. Discharge conversations with families should include pain management, changes to activities of daily living, family routines and play, and expectations for fracture healing.

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Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial

Cited by 4 publications

References 18 publications

Distal Radius Fractures in Childhood - Our Five-Year Experience

Distal Radius Fractures in Childhood - Our Five-Year Experience

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

Parental Perspectives on Children's Functional Experiences After Limb Fracture

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