Outcomes of Long-arm Casting Versus Double–Sugar-Tong Splinting of Acute Pediatric Distal Forearm Fractures

Levy, Jeffrey S.; Ernat, Justin J.; Song, Daniel J.; Cook, Jay B.; Judd, Daniel B.; Shaha, Steven H.

doi:10.1097/bpo.0000000000000196

Cited by 14 publications

(20 citation statements)

References 11 publications

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“…Furthermore, recent reports from Wendling-Keim et al [13] and Roth et al [14] have shown that the guidelines regarding acceptable angulation that we have followed might have been too strict and that even larger angulations do not result in poor outcomes. The rate of secondary displacements in our study (31% of patients experienced a secondary displacement, whereas 20% required a secondary procedure) is comparable with recent reports by Levy et al [15] (33% with secondary displacement), Khandekar et al [10] (45% with secondary displacement) and Wendling-Keim et al [13] (14.5% of patients requiring a secondary procedure). We believe that these facts justify our conservative strategy in the initial treatment of displaced distal forearm fractures in children.…”

Section: Discussionsupporting

confidence: 91%

Secondary displacement in distal forearm fractures in children: adequate positioning of the wrist in the cast is more important than cast index

Kralj

Pešorda

Keretić

et al. 2022

Journal of Pediatric Orthopaedics B

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The objective of this study was to assess whether the positioning of the wrist joint in the cast in such a manner that it counteracts the direction of angulation of fragments is more important than the cast index in the prevention of secondary displacements in distal forearm fractures. A retrospective review of all pediatric patients (0–16 years of age) who were hospitalized in our institution with displaced fractures of the distal forearm (either isolated fractures of the distal radius or both bone fractures) who underwent subsequent closed reduction and splinting in the period from August 2018 to October 2020. Patients with physeal fractures and open fractures, and skeletally mature patients were excluded from the study. Patients were divided into two categories – the first one in which the cast index was below 0.9 and the second in which it was above 0.9. In each category, we have identified two groups of patients – the first one in whom the wrist joint was positioned in such a manner that it counteracts the direction of angulation of fracture fragments and the second one in whom the wrist joint was in a neutral position. The two groups in each category have been compared according to age, sex, initial angulation, fracture type (isolated radius or both bone fractures), displacement type (angulation or complete dislocation) and the rate of secondary displacement. In both categories, the two groups were comparable according to age, sex, initial angulation, fracture and displacement type. In both categories (cast index below 0.9 and cast index above 0.9), a statistically significant higher portion of patients with secondary displacement was identified in the group of patients who had the wrist joint in a neutral position (Z = −2.1997; P = 0.0278 – for cast index <0.9 and Z = −2.1672; P = 0.030216 for cast index >0.9). Our research supports the notion that positioning of the wrist joint in the position that counteracts the force that leads to angulation of fracture fragments is more important than the cast index in the prevention of secondary displacements in pediatric distal forearm fractures.

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Section: Discussionsupporting

confidence: 91%

Secondary displacement in distal forearm fractures in children: adequate positioning of the wrist in the cast is more important than cast index

Kralj

Pešorda

Keretić

et al. 2022

Journal of Pediatric Orthopaedics B

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“…However, there was no difference between groups at cast removal. 23 In the current study, only 19% of fractures with unacceptable alignment at follow-up underwent operative intervention, and the average age of those patients was 15.7 years compared with 8.7 years for patients with unacceptable alignment who did not receive interventions. It has been suggested that reluctance to perform remanipulation for younger patients with malaligned both bone forearm fractures was influenced by remaining growth potential to correct residual deformities.…”

Section: Discussionmentioning

confidence: 54%

“…A possible explanation for this finding is poor immobilization with the use of a sugar-tong splint and fiberglass overwrap before conversion to a short arm cast. Levy et al 23 performed a prospective randomized trial comparing maintenance of reduction for distal radius and distal both bone forearm fractures with either a long arm cast or a sugar-tong splint converted to a short arm cast after 1 week. They found better postreduction alignment, less loss of reduction, and less need for remanipulation with sugar-tong splints.…”

Section: Discussionmentioning

confidence: 99%

Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures

Morrison¹,

Carender²,

Kilbane³

et al. 2017

Orthopedics

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Effective treatment of pediatric both bone forearm fractures consists of timely restoration of anatomic alignment with manipulation and immobilization, often accomplished with the aid of procedural sedation in the emergency department setting. The current lack of consensus regarding a safe and optimal regimen may result in inadequate sedation, compromised quality of reduction, or patient harm. The current study was conducted to answer the following questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation: (1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? (2) Is there a difference in the rates of major sedation-related complications? Medical records, data on procedural sedation, and radiographs of 74 skeletally immature patients with diaphyseal or distal metaphyseal both bone forearm fractures treated with manipulation were reviewed (ketamine sedation, 26; propofol sedation, 48). Rates of unacceptable alignment for the 2 cohorts were similar both immediately after reduction and at 4 weeks. Rates of complications of procedural sedation did not differ between cohorts. The duration of procedural sedation was longer and the padding index was greater with ketamine. Malalignment after reduction was more likely in older patients and those with a higher padding index. Although no difference was found in the rates of malalignment or sedation-related complications between fractures reduced with ketamine or propofol sedation, the sedation regimens differ in both procedural duration and padding index. Careful consideration of the risks and benefits of procedural sedation for closed reduction of pediatric forearm fractures is warranted. [Orthopedics. 2017; 40(5):288-294.].

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“…1 Presence of tough periosteum and continued remodelling makes them suitable for non-operative treatment. 2,3 The treatment of choice has been a long-arm cast (LAC) with threepoint fixation following closed reduction. 3,4 The double sugar-tong splint (DSTS) is a long-arm plaster construct that prevents pronation-supination and limits flexionextension of the elbow, effective to provide threepoint fixation, with the advantage of reduced risk of compartment syndrome and can even be applied in presence of significant swelling where long arm cast is contraindicated.…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of long-arm cast versus double sugartong splint in acute paediatric distal forearm fractures: A randomised controlled trial

Banjade

Adhikari

et al. 2022

J. Kathmandu Med. Coll.

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Background: The treatment of choice for paediatric distal forearm fractures has been a long-arm cast (LAC) following closed reduction. An alternative treatment is to use a double sugar-tong splint (DSTS), found equally effective to provide three-point fixation and comparable outcomes to cast. Objectives: To compare the functional outcome between LAC and DSTS for the treatment of paediatric distal forearm fractures. Methods: A randomised controlled trial was done among 36 patients of 5-15 years with acute distal forearm fractures without neurovascular deficit treated with LAC and DSTS recruited by convenience sampling at a tertiary care centre after ethical approval. Acceptability of reduction, loss of reduction, union rates, cast comfort, range of motion and complications were studied at follow-up upto 12 weeks and analysed using SPSS v.11.5. Results: Among a total of 36 patients, 18 cases were treated by the LAC method and others by the DSTS method. Both LAC and DSTS were comparable in the maintenance of reduction, the remanipulation rate was 8.3% (n = 3), not significant (p-value = 0.967). All had a union at six weeks follow-up. No statistical difference in mean VAS score (p-value = 0.524), mean loss of flexion (p-value = 0.397), and mean loss of pronation/supination (p-value = 0.814). No statistically significant difference in activities of daily living was noted. No complications were encountered. Conclusion: DSTS is safe and as effective as LAC in the treatment of distal forearm fractures in children, identical in terms of functional outcome, maintenance of reduction, complications, and time to union.

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Outcomes of Long-arm Casting Versus Double–Sugar-Tong Splinting of Acute Pediatric Distal Forearm Fractures

Abstract: Level II-prospective, comparative study.

Cited by 14 publications

References 11 publications

Secondary displacement in distal forearm fractures in children: adequate positioning of the wrist in the cast is more important than cast index

Secondary displacement in distal forearm fractures in children: adequate positioning of the wrist in the cast is more important than cast index

Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures

Functional outcome of long-arm cast versus double sugartong splint in acute paediatric distal forearm fractures: A randomised controlled trial

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