The treatment of stable paediatric forearm fractures using a cast that may be removed at home

Abstract

We investigated whether, in the management of stable paediatric fractures of the forearm, flexible casts that can be removed at home are as clinically effective, cost-effective and acceptable to both patient and parent as management using a cast conventionally removed in hospital. A single-centre randomised controlled trial was performed on 317 children with a mean age of 9.3 years (2 to 16). No significant differences were seen in the change in Childhood Health Assessment Questionnaire index score (p = 0.10) or EuroQol 5-Dimensions domain scores between the two groups one week after removal of the cast or the absolute scores at six months. There was a significantly lower overall median treatment cost in the group whose casts were removed at home (£150.88 (sem 1.90) vs £251.62 (sem 2.68); p < 0.001). No difference was seen in satisfaction between the two groups (p = 0.48).

Changing trends in the management of children’s fractures

“…It has also been suggested that synthetic casts give better results than traditional plaster casts. 113 However, 114 re-displacement may occur in up to 32.3% of fractures, resulting in further intervention. 115 The risk of redisplacement is related to stability at the site of fracture, the location of the fracture, and the quality of reduction and cast application.…”

Buckled, bent or broken? A guide to paediatric forearm fractures

“…The majority of the cortex remains intact, and torus fractures are therefore inherently stable. They can be managed appropriately with a range of immobilisation methods from casts to removable splints, 6,7 balancing adequate immobilisation for pain relief against compliance, convenience and costs related to follow-up. A removable splint provides adequate protection while being easily removed by parents at home after a 3-4-week treatment period without further clinical or radiographic followup.…”

“…A removable splint provides adequate protection while being easily removed by parents at home after a 3-4-week treatment period without further clinical or radiographic followup. 6,7 Sports, high impact and loading should be avoided for a further four weeks.…”

Children's forearm fractures

“…It has been shown in a randomized controlled trial that these fractures may be treated satisfactorily with a flexible cast, removed at home after 3 weeks. 12 Many centres treat torus fractures satisfactorily with a removable wrist splint, patient advice leaflet for the parents and discharge from further follow up. 0 Moulded cast immobilization in the plaster room when the fracture is in a satisfactory position 0 Closed reduction and application of a moulded cast (usually in theatre under general anaesthetic) ➢ Applying a well moulded plaster cast is a vital skill when managing forearm fractures.…”