The Effects of Splitting an Above Elbow Cast: A biomechanical study

Vokes, Jordan; Obudzinski, Sarah; Knapp, Emma; O'Malley, Sandra; Awad, Hani A.; O’Malley, Natasha T.

doi:10.1016/j.injury.2020.05.027

Cited by 1 publication

(1 citation statement)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there is sparse literature on the efficacy of bivalving lower leg casts in the pediatric population, there is a recent evidence that highlights the benefits of this technique for upper extremity casts. A biomechanical study by Vokes et al 23 found confirmed that bivalving of casts lowers compartmental pressure and this reduction in pressure was confirmed in a 2015 randomized controlled trial by Zaino et al 24 However, more studies are certainly warranted regarding the utility of bivalving of casts in this specific patient population.…”

Section: Discussionmentioning

confidence: 92%

Nonoperative Management of Closed Displaced Tibia Shaft Fractures in Patients Under 18 Years of Age: Low Failure Rate

Cummings

Rivera²,

Pereira³

et al. 2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Tibial shaft fractures are the third most common pediatric long bone fracture pattern. Historically, these fractures have been initially treated with closed reduction and casting (CRC). Recently, there has been an increasing trend toward surgical intervention as an initial treatment for these injuries. In an effort to better understand whether this trend is warranted, this study seeks to characterize the clinical and radiographic outcomes of a large number of children who underwent nonoperative treatment with CRC as their initial treatment for pediatric tibial shaft fractures at a single tertiary care center. Methods: Outcomes measured included final alignment, other procedures performed, length of time to full radiographic healing, and length of time in each method of immobilization before progressing to full weight-bearing status. Patients were separated by ages into the following cohorts during statistical analysis: 4 to 8 years, 9 to 12 years, and 13+ years. Differences between continuous variables were analyzed with independent-samples t tests. χ2 tests were used to analyze differences in categorical variables. An α<0.05 was considered statistically significant. Results: A total of 137 patients met our inclusion criteria. The median age was 10.19 years (4.03 to 17.43). The average initial displacement among all age groups was 27.42% (±15.05%). After the initial intervention with CRC, all age groups demonstrated an average of <5 degrees of residual angulation and <20% of residual displacement. Complete radiographic healing was seen in 127 (92.7%) patients by 3 months. Loss of reduction requiring additional clinical intervention was seen in 30 (21.9%) patients with only 5% requiring surgical intervention, whereas malunion was seen in a total of 16 (11.7%) patients at the final visit. There were no cases of compartment syndrome or deep wound infection. Male and initial angulation were the only factors predictive of loss of reduction. Conclusion: Initial intervention with CRC is a safe and effective treatment for the majority of children in all age groups presenting with tibial shaft fractures demonstrating minimal angulation and displacement with surgical intervention being required in only 5% of patients. Further studies are warranted to elucidate the characteristics of patients who may benefit most from initial surgical intervention. Level of Evidence: Level III—retrospective study.

show abstract

Section: Discussionmentioning

confidence: 92%