Conversion to below-elbow cast after 3 weeks is safe for diaphyseal both-bone forearm fractures in children

Joost W Colaris, Jan Hein Allema, L Ulas Biter, Max Reijman, Cees P van de Ven, Mark R de Vries, Rolf M Bloem, Albert J H Kerver, Jan A N Verhaar, Joost W Colaris, Jan Hein Allema, L Ulas Biter, Max Reijman, Cees P van de Ven, Mark R de Vries, Rolf M Bloem, Albert J H Kerver, Jan A N Verhaar

Abstract

Background: It is unclear whether it is safe to convert above-elbow cast (AEC) to below-elbow cast (BEC) in a child who has sustained a displaced diaphyseal both-bone forearm fracture that is stable after reduction. In this multicenter study, we wanted to answer the question: does early conversion to BEC cause similar forearm rotation to that after treatment with AEC alone?

Children and methods: Children were randomly allocated to 6 weeks of AEC, or 3 weeks of AEC followed by 3 weeks of BEC. The primary outcome was limitation of pronation/supination after 6 months. The secondary outcomes were re-displacement of the fracture, limitation of flexion/extension of the wrist and elbow, complication rate, cast comfort, complaints in daily life, and cosmetics of the fractured arm.

Results: 62 children were treated with 6 weeks of AEC, and 65 children were treated with 3 weeks of AEC plus 3 weeks of BEC. The follow-up rate was 60/62 and 64/65, respectively with a mean time of 6.9 (4.7-13) months. The limitation of pronation/supination was similar in both groups (18 degrees for the AEC group and 11 degrees for the AEC/BEC group). The secondary outcomes were similar in both groups, with the exception of cast comfort, which was in favor of the AEC/BEC group.

Interpretation: Early conversion to BEC cast is safe and results in greater cast comfort.

Figures

Figure 1.
Figure 1.
A displaced diaphyseal both-bone fracture.
Figure 2.
Figure 2.
Flow chart of enrollment in the study.

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