Plaster versus Ortho-Glass®: Does Initial Splint Material Matter in Pediatric Forearm Fracture Outcomes? A Randomized, Prospective Trial

Abstract

Background: Various techniques of non-operative management of pediatric forearm fractures have proven to be successful in avoiding surgical risk and obtaining acceptable outcomes for patients. However, the ability of plaster versus fiberglass splint material to maintain reduction of these fractures has not been compared. Our goal was to determine whether splint material affects the success of non-operative management of pediatric forearm fractures.Methods: All patients aged 0-18 years with a traumatic forearm fracture requiring reduction were enrolled prospectively and randomized to fiberglass (Ortho-Glass®, Essity Medical Solutions, Charlotte, NC) or plaster sugartong splints. A total of 230 patients met inclusion criteria: 90 randomized to plaster and 140 to fiberglass. Patients were stratified based on location of fracture: distal radius fractures (DRF), middle both bone forearm fractures (BBFFx), and proximal BBFFx. Radiographic outcomes including residual deformity and clinical outcomes including conversion to surgery were evaluated in all patients. Statistical analysis was performed with t-test, Wilcoxon rank sum, Chi-Square, or Fisher's exact tests where applicable.Results: Radiographic and clinical outcomes were similar between fiberglass and plaster splints. Overall, only 2.6% of patients required conversion to surgery, 1.1% of the plaster cohort and 3.6% of the fiberglass cohort (p=0.41). No patients required re-reduction with sedation. At final follow-up, 32.5% of middle or proximal BBFFx and 1.3% of DRF healed in “unacceptable” alignment according to classically described guidelines.Conclusions: There is no difference in the effectiveness of fiberglass or plaster sugartong splints for initial immobilization of pediatric BBFFx and DRF. Rates of conversion to surgery were lower in both groups than previously described. However, there was a trend toward treating “unacceptably” aligned forearm fractures non-operatively and more research is indicated to determine the long-term clinical significance.Level of Evidence: Level IKey Concepts•Splint material is not a contributing factor to maintaining reduction of distal radius and both bone forearm fractures in children.•Closed reduction and sugartong splinting of pediatric distal radius and both bone forearm fractures provide favorable outcomes with low surgical conversion rate.