Abstract
Distal forearm fracture is the most common fracture in childhood. Patients with this type of injury suffer from meaningful pain after Emergency Department (ED) discharge. Previous studies demonstrated that short arm (below-the-elbow) casts perform as well as long arm (above-the-elbow) casts for maintaining the reduction of distal forearm fractures, with a similar rate of complications. Consequently, short casts are the commonly used method of immobilization after closed reduction of a distal forearm fractures in children older than 4 years. However, short casts carry a potential disadvantage; since they cannot prevent supination in a wrist that is held in pronation, and vice versa, their use might be associated with pain.We initiated this study to examine the effect of the type of casting on post discharge pain. We will conduct an open-label randomized, controlled trial comparing short cast immobilization with long cast immobilization in children who had a reduction of distal forearm fracture in the ED. Our hypothesis is that children with distal forearm fractures who are treated with a long cast, experience less pain during the first 48 h after ED discharge than children who are treated with a short cast.
Highlights
Distal forearm fractures (DFF) are the most common fractures in childhood
Previous studies show that children treated with a long cast missed significantly more days of school and were more likely to require assistance with various activities of daily living activities compared to children who were treated with a short cast [6,9]
In children under the age of 4 years, a long cast is still recommended, as short arm casts may slip [11]
Summary
Distal forearm fractures (DFF) are the most common fractures in childhood Most of these injuries are successfully treated non-operatively with closed reduction under procedural sedation and cast immobilization. Contrary to the fracture-care principle of immobilizing the joint proximal to and distal to a fracture, it appears that the immobilization of the long cast offers no benefit in maintaining the alignment of these fractures. This may be because the elbow joint is distant from the fracture, and the majority of immobilization is secured over the length of the forearm. A previous study that analyzed pain after reduction and casting of different types of upper extremity fractures using the long version of the Parents' Postoperative Pain Measure (PPPM), demonstrated that many patients had clinically meaningful pain in the first 48–72 h after ED discharge [15,16,17,18]
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