Above and Below-the-Elbow Plaster Casts for Distal Forearm Fractures in Children

Bohm, Éric; Bubbar, V.; Hing, Ken Yong; Dzus, Anne

doi:10.2106/00004623-200601000-00001

Cited by 35 publications

(62 citation statements)

References 16 publications

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“…In contrast to recommendations for repeated radiographs at 1, 2, and 3 weeks and at the time of cast removal [6][7][8], the results of the present study show that the performance of fewer X-rays at appropriate times during the management of forearm fractures will yield reliable results with no loss in quality of care.…”

Section: Discussioncontrasting

confidence: 95%

“…Previous studies have noted that fractures requiring reduction tend to redisplace in the cast [2,8], and most authors recommend radiographic follow-up for reduced fractures as frequently as weekly for 2 or 4 weeks [6,8]. However, we noted a relatively low rate of in-cast redisplacement after nonoperative reduction (9 of 111 patients).…”

Section: Discussionmentioning

confidence: 58%

“…In children with forearm fractures, repeated radiographic examinations are recommended during cast immobilization, for early detection of fracture displacement, and at cast removal, to assess fracture consolidation [2,6,8]. However, this exposes the children to antero-posterior and lateral radiation at least 5-6 times within a 4-to 6-week period, in addition to the imaging intensifier radiation at fracture reduction.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies recommend repeated radiographic examinations at 1, 2, and even 3 weeks after initial fracture management for the early detection of in-cast displacement and, again, at the time of cast removal to assess healing [6][7][8]. However, the value of frequent radiographic followup and the indications for radiographic examination after cast removal have hardly been defined in scientific studies [7].…”

Section: Introductionmentioning

confidence: 99%

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Are frequent radiographs necessary in the management of closed forearm fractures in children?

Chen

Katz

Weigl

et al. 2008

Journal of Children's Orthopaedics

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Introduction A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China. Methods The sample consisted of 202 consecutive children (mean age 7 years; range 3-12 years) with closed forearm fractures treated nonoperatively. Children with open, growth-plate fractures or fractures associated with dislocation of the nearby joint (i.e., monteggia fractures) were excluded. In 28 children who had torus fractures, radiographic examination was performed at the time of cast removal, 3 weeks after the start of treatment. In 63 children who had stable fractures that did not require reduction (undisplaced or minimally displaced, complete or greenstick), radiographic examination was performed 1 week after the start of treatment and again at cast removal 4-6 weeks later. In the remaining 111 children with complete, displaced, or greenstick fractures (all with angulation of more than 15°) who underwent closed reduction, an additional X-ray was taken 2 weeks after cast placement. All children (except those with torus fractures) were followed clinically, without further radiographic examination, for 3 months after cast removal. Results Radiographs at cast removal showed good union in all stable fractures, indicating that additional X-rays on cast removal would have had no added value. In the children with unstable fractures, only 9 showed redisplacement with angulation of more than 15°on repeated X-rays during the first 2 weeks after cast placement. All 9 underwent successful re-reduction. On clinical evaluation 3 months after cast removal, all patients in the sample had full range of elbow and forearm motion. Repeated fracture did not occur in any of the patients. Conclusions On the basis of these results, radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures. At the time of cast removal, if clinical examination does not show signs of nonunion or malalignment, no radiographic examination is necessary.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Are frequent radiographs necessary in the management of closed forearm fractures in children?

Chen

Katz

Weigl

et al. 2008

Journal of Children's Orthopaedics

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“…F ractures of the distal radius are the most common fracture in childhood 1 and a frequent reason for visits to the emergency department. 2 Although such fractures are often angulated at the time of injury, physicians often accept those with minimal angulation (≤ 15°) because of the unique capacity of skeletally immature bones in children to heal through remodelling.…”

mentioning

confidence: 99%

Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

Boutis¹,

Willan²,

Babyn³

et al. 2010

Canadian Medical Association Journal

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Think twice before re-manipulating distal metaphyseal forearm fractures in children

Roth

Denk

Colaris

et al. 2014

Arch Orthop Trauma Surg

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Re-manipulation of distal forearm fractures in children <12 years did not improve outcomes, deeming re-manipulations unnecessary. Children ≥12 years in the conservative group achieved satisfactory outcomes despite re-angulations exceeding current guidelines. Based on observed remodelling, we now accept up to 30° angulation in children <9 years; 25° angulation in children aged 9-<12; 20° angulation in children ≥12 years, when re-angulation occurs. We conclude that clinicians should be more reluctant to perform re-manipulations.

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Above and Below-the-Elbow Plaster Casts for Distal Forearm Fractures in Children

Cited by 35 publications

References 16 publications

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

Think twice before re-manipulating distal metaphyseal forearm fractures in children

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