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

Abstract

Purpose: The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients.

Methods: A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow.

Results: No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item "help needed with showering in the first days after trauma" (SAC 60%, LAC 87%, P = 0.001).

Conclusion: Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering.

Trial registration: NCT03297047, September 29, 2017.

Keywords: Closed reduction; Distal forearm fracture; Fiberglass cast; Long-arm cast; Paediatrics; Short-arm cast.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1

CONSORT (Consolidated Standards of Reporting Trials) diagram, showing participant flow, patients screened, excluded, randomized, followed, and analyzed in this study

Fig. 2

Analysis of variance (ANOVA) of fracture angulation in degrees between time points (on days 0, 5, 10, and 28). SAC, short-arm cast; LAC, long-arm cast; PA, posteroanterior. a radial angulation on PA X-ray (P = 0.65); b ulnar angulation on PA X-ray (P = 0.01); c radial angulation on lateral X-ray (P = 0.7); d ulnar angulation on lateral X-ray (P = 0.8)

Fig. 3

Two cases of metaphyseal fractures with posteroanterior and lateral radiographs at initial presentation before closed reduction and after 28 days. a–d show the X-rays of a 10-year-old female patient treated with a SAC. The initial X-rays before treatment (a, b) and the X-rays after 4 weeks (c, d) are shown. Unrestricted movement of the elbow was possible at the time of cast removal with a normal ROM of the elbow 3 weeks later (extension/flexion 0/0/150°). e–g A 12-year-old male patient treated with a LAC. e and f show the fracture before closed reduction, g and h after 4 weeks of LAC treatment. Restricted range of movement of the elbow for 9 days after cast removal. Three weeks later, ROM of the elbow was 0/0/140°

Fig. 4

Graphical display of ROM of elbow flexion and extension 3 weeks after cast removal, comparing short-arm cast (SAC) versus long-arm cast (LAC)

Fig. 5

Time period to regain normal elbow mobility, (d, days; y, years). Graph illustrating Pearson correlation for the time needed in different age groups (r = 0.19)