Early conversion to below-elbow cast for non-reduced diaphyseal both-bone forearm fractures in children is safe: preliminary results of a multicentre randomised controlled trial

Abstract

This multicentre randomised controlled trial was designed to explore whether 6weeks above-elbow cast (AEC) or 3weeks AEC followed by 3weeks below-elbow cast (BEC) cause similar limitation of pronation and supination in non-reduced diaphyseal both-bone forearm fractures in children. Children were randomly allocated to 6weeks AEC or to 3weeks AEC followed by 3weeks BEC. The primary outcome was limitation of pronation and supination after 6months. The secondary outcomes were re-displacement of the fracture, complication rate, limitation of flexion and extension of wrist and elbow, cast comfort, cosmetics, complaints in daily life and assessment of radiographs. A group of 23 children was treated with 6weeks AEC and 24 children with 3weeks AEC and 3weeks BEC. The follow-up rate was 98% with a mean follow-up of 7.0months. The mean limitation of pronation and supination was 23.3±22.0 for children treated with AEC and 18.0±16.9 for children treated with AEC and BEC. The other study outcomes were similar in both groups. Early conversion to BEC is safe in the treatment of non-reduced diaphyseal both-bone forearm fractures in children. Multicentre randomised controlled trial, Level II.