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

Colaris JW, Allema JH, Biter LU, Reijman M, van de Ven CP, de Vries MR, Bloem RM, Kerver AJ, Verhaar JA - Acta Orthop (2013)

Bottom Line: The primary outcome was limitation of pronation/supination after 6 months.The secondary outcomes were similar in both groups, with the exception of cast comfort, which was in favor of the AEC/BEC group.Early conversion to BEC cast is safe and results in greater cast comfort.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery , Erasmus Medical Center , Rotterdam.

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.

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Related in: MedlinePlus

A displaced diaphyseal both-bone fracture.
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Figure 1: A displaced diaphyseal both-bone fracture.

Mentions: We included all children aged < 16 years who sustained a displaced diaphyseal both-bone forearm fracture that was stable after reduction (Figure 1). A diaphyseal fracture was defined as a fracture in the shaft of the bone between the distal and proximal metaphysis. The criteria for reduction are given in Table 1. Exclusion criteria were unstable fractures, fractures older than 1 week, severe open fractures (Gustilo II and III), and refractures.


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

Colaris JW, Allema JH, Biter LU, Reijman M, van de Ven CP, de Vries MR, Bloem RM, Kerver AJ, Verhaar JA - Acta Orthop (2013)

A displaced diaphyseal both-bone fracture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3822135&req=5

Figure 1: A displaced diaphyseal both-bone fracture.
Mentions: We included all children aged < 16 years who sustained a displaced diaphyseal both-bone forearm fracture that was stable after reduction (Figure 1). A diaphyseal fracture was defined as a fracture in the shaft of the bone between the distal and proximal metaphysis. The criteria for reduction are given in Table 1. Exclusion criteria were unstable fractures, fractures older than 1 week, severe open fractures (Gustilo II and III), and refractures.

Bottom Line: The primary outcome was limitation of pronation/supination after 6 months.The secondary outcomes were similar in both groups, with the exception of cast comfort, which was in favor of the AEC/BEC group.Early conversion to BEC cast is safe and results in greater cast comfort.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery , Erasmus Medical Center , Rotterdam.

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.

Show MeSH
Related in: MedlinePlus