Is Univalving or Bivalving of Long Arm Casts for Forearm Fractures Necessary?

Not Applicable

Completed

Conditions: Fracture of Shaft of Radius and/or Ulna
Metaphyseal Fracture of Bone of Upper Limb
Fracture of Upper Limb, Level Unspecified

Interventions: Procedure: No Split Cast of forearm fractures
Procedure: Bivalve Split Cast of forearm fractures
Procedure: Univalve Split Cast of forearm fractures

Brief Summary: This study aims to examine the need for univalve or bivalve splitting of casts in pediatric patients with forearm fractures following closed reduction and cast application in a randomized, prospective fashion.

Detailed Description: Following cast application, little is known regarding the need to split the cast, either in a univalve (a split along a single side of the cast) or bivalve (a split along both sides of the cast) fashion. Theoretically, the splitting of the cast allows for expansion and soft tissue swelling. However, review of the literature yields a paucity of evidence demonstrating the efficacy of splitting a cast. In a study by Nietosvaara et. al, a retrospective examination of 109 pediatric patients initially treated with closed cylindrical casting for closed forearm fractures were evaluated. Of these 109 patients, one-sixth required the initial cast to be split, trimmed, or removed secondary to post-traumatic swelling.

However, the splitting of a cast is not without risks in itself. Once the initial swelling dissipates, a univalved or bivalved cast can become excessively loose. This loosening has been associated with a loss of reduction. If the loss or reduction is substantial, it may require a re-reduction or operation to correct. In addition, with every use of the cast saw a patient is placed at risk for iatrogenic cast saw injury. Thermal burns and abrasions from cast saws can cause lifelong emotional and physical scars for a patient. They can also be an inciting event for litigation against the hospital and or provider, with settlements averaging greater than $12,000 per centimeter of cast saw injury.

Recruitment & Eligibility

Inclusion Criteria

A closed isolated radial and/or ulna fracture of the forearm inclusive of metaphyseal and/or shaft level fractures.
Forearm fractures that require closed reduction (with or without conscious sedation)
Patients between the ages of 3 and 12 years old

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
No split Cast of forearm fractures	No Split Cast of forearm fractures	Patient will have a "No split cast" long arm cast applied after a closed reduction of forearm fractures. The cast will not be split. 20 patients will be randomized to this arm.
Bivalve Split Cast of forearm fractures	Bivalve Split Cast of forearm fractures	Patients will have a "Bivalve Split Cast" long arm cast applied after they have undergone a closed reduction of of forearm fractures. This is a cast that will be split on both sides of the cast. 20 patients will be randomized to the bivalve split arm cast.
Univalve Split Cast of forearm fractures	Univalve Split Cast of forearm fractures	Patients will have a "Univalve Split Cast" long arm cast applied after undergoing closed reduction of of forearm fractures. This is a cast that is split on only one side of the cast. 20 patients will be randomized to this arm

Primary Outcome Measures

Name	Time	Method
Complication Rate of the Cast Type	<60 days corresponding to total study time and consistent with outcome 6	This data will be able to help physicians and ER personnel help this patient population with the least number of cast complications and therefore allow for a more efficient use of resources since cast modifications could be minimized. Metrics used to characterize complications are the radiographic union used to determine speed of healing and the number of unplanned ER or clinic visits for cast modifications.

Secondary Outcome Measures