Comparison of distal third forearm fractures in children treated with above elbow verses below elbow cast.

Abstract

In childhood most common fractures are closed fracture of the distal third of the forearm in children, after closed reduction of the forearm fractures of distal third were immobilized with long arm cast and by some orthopedic surgeon with short arm cast. Objectives: To compare the result of above elbow cast with below elbow cast in the treatment of distal third forearm fractures in children. Study Design: Randomized study. Setting: Department of orthopedics, Allied Hospital, Faisalabad. Period: One year 14-Sep, 2015 to 15-Aug, 2016. Results: 180 Cases fulfilling the inclusion / exclusion criteria were included in the study. In group A38.89% (%35) in our study and group B 45.56% (n=41) were between 1-6 years of age while. In group A 61.11% (n=55) and group B 54.44% (n=49) were 7-12 years of age of the children mean + sd 7.66 + 2.54 and 7.38 + 2.46 years respectively, In group A 58.89 % (n=53) in group B 62.22% (n=56) were male while group –A 41-11% (N37) and in group B 37.78% were females below elbow cast compared with above elbow cast in treating distal one third forearm fracture in children shows that group A 23.33% (n+21) and group B 30% (n=27) and re displacement shows no significant difference between their two groups. Conclusion: We concluded there is no significant difference in outcome of above elbow cast with below elbow cast after reduction treating the fracture of children in distal on third forearm fractures.

Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials

“…Sensitivity analysis was conducted with the exclusion of studies associated with high risk of bias. 15,17,19 Another sensitivity analysis was conducted to evaluate if excluding articles 9,14,16 with children elder than 12 years of age would affect the results on the basis that these studies had adolescent patients compared with other studies with children younger than 12 years of age. Egger's test with funnel plot was performed for our primary outcome, the risk of loss of fracture reduction.…”

“…We excluded studies with high risk of bias and children more than 12 years of age in our sensitivity analyses. This was based on analyzing high-quality studies and considering that adolescent fractures might be treated as 19 --Manzoor et al 17 adult injuries that require surgical treatment to achieve and maintain fracture reduction. Loss of fracture reduction is the most common complication after closed reduction and cast immobilization in the management of displaced distal forearm fractures in children.…”

“…Memon et al 18 described only the mean loss of fracture reduction for each group, resulting in an incapability to pool data for the meta-analysis. Sensitivity analysis was conducted and excluded studies with high risk of bias (15,17,19). Seven of the studies reported re-manipulation rates and a total of five studies reported cast-related complications.…”

“…The random-effects model meta-analysis of the eight RCTs concluded an overall RR of 0.74 (95% confidence interval (CI) = 0.49, 1.13, p = 0.07, I 2 = 47%), which proposed a lower rate of loss of fracture reduction in children who had BEC treatment, but this difference did not reach a statistical significance (p = 0.14). However, sensitivity analysis following exclusion of studies with high risk of bias (15,17,19) showed that loss of fracture reduction was in favor of BEC with statistical significance (RR = 0.6, 95% CI = 0.38, 0.96) (Figure 3). Egger's test did not indicate the presence of publication bias.…”

“…14,15 Due to heterogeneity, the meta-analysis failed to generate robust conclusions and hence has provoked additional RCTs to answer this question. Since the updated meta-analysis, four additional recent RCTs [16][17][18][19] with larger sample sizes have been published.…”