A Single Sugar-Tong Splint Can Maintain Pediatric Forearm Fractures

Abstract

Displaced pediatric forearm fractures often are treated with closed reduction and immobilization. Recent literature demonstrates no difference in maintaining alignment or needing repeat intervention in patients immobilized with either a single sugar-tong splint or a long-arm cast, but most series include patients with distal fractures. This study included patients 3 to 15 years old who underwent closed reduction and immobilization for displaced midshaft or proximal forearm fractures. Radiographs from the time of injury, after reduction, and at 4-week follow-up were reviewed for coronal and sagittal plane angular alignment. Secondary interventions also were recorded. A total of 121 patients (70 long-arm cast, 51 simple sugar-tong splint) met inclusion criteria. Groups were matched in terms of age ( P =.95), sex ( P =.41), body mass index ( P =.12), and angular deformity prior to reduction in the sagittal ( P =.78) and coronal ( P =.83) planes. Following closed reduction, sagittal ( P =.003) and coronal ( P =.002) alignment improved significantly in all patients. At 4-week follow-up, there were no significant differences in sagittal ( P =.15) or coronal ( P =.68) alignment between the 2 groups. Nine patients underwent a secondary intervention after the index reduction (long-arm cast, n=7; simple sugar-tong splint, n=2), with no statistically significant difference between groups ( P =.30). There were no statistically significant differences between patients managed with long-arm cast or simple sugar-tong splint regarding residual sagittal or coronal plane deformity at 4-week follow-up or incidence of secondary intervention. These findings indicate simple sugar-tong splint and long-arm cast appear to be acceptable and equivalent methods of immobilization for these injuries. [ Orthopedics . 2021;44(2):e178–e182.]

A comparison of two immobilization methods in the conservative treatment of pediatric distal forearm fractures: Long arm cast versus single sugar-tong splint

“…The aforementioned authors retrospectively studied the fixation results with SSTS (n=51) and LAC (n=70) in pediatric forearm fractures with a larger number of patients later and reported that both methods were acceptable and equivalent methods of immobilization for these injuries. [18] Dittmer et al [9] published the results of 168 pediatric forearm fractures immobilized with STS and reported that STS was effective in maintaining the reduction of pediatric forearm fractures, similar to published rates for casting. Of note, relative to the study of Dittmer et al, [9] there were more cases in our study and these authors did not have a control group.…”

“…Of note, relative to the study of Dittmer et al,[ 9 ] there were more cases in our study and these authors did not have a control group. Moreover, the studies of Dittmer et al[ 9 ] and Murphy et al[ 7 , 18 ] consist of all forearm fractures, while the current study includes more specific and regionally homogeneous distal forearm fractures.…”

“…Successful results of STS in childhood forearm fractures have been published in recent years. [7,9,[17][18][19][20] Denes et al [19] published the results of 53 children with distal radius fractures with SSTS and reported that 51 cases were successfully treated. We also found successful results in immobilization with SSTS, and while Denes et al [19] did not have a control group, in our study, cases immobilized with LAC were studied as the control group with a higher number of cases.…”

Comparison of the forearm rotation restriction capacities of four upper-extremity immobilization methods: there is no difference between single and double sugar tong splinting

“…Studies have shown that SSTSs are effective for the treatment of forearm and wrist fractures [ 5 , 7 ]. Moreover, DSTSs are preferred for patient groups similar to those treated with SSTSs and are successful at immobilization [ 6 ].…”

Clinical Follow-Up without Radiographs Is Sufficient after Most Nonoperatively Treated Distal Radius Fractures in Children

“…Fractures near the physis in young children have the greatest potential to remodel. Most pediatric distal forearm fractures can be treated nonoperatively [13] by casting or splinting [14] with or without a closed reduction. Loss of alignment of distal radius fractures after nonoperative treatment is common, with a rate reported between 7% and 91% [13,[15][16][17][18].…”