Using semi-rigid casts in the management of buckle fractures

Taranu, Razvan; Webb, J. B.; Brown, Gillian; Bowler, Carol; Bayliss, Neil

doi:10.7748/paed.23.2.25.s25

Cited by 4 publications

(8 citation statements)

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“…18 One study only recorded RTS as time after cast removal; however, the casting time was variable among patients, so RTS time from initial injury could not be calculated. 29…”

Section: Resultsmentioning

confidence: 99%

“…One article made recommendations for RTS after distal radius buckle fractures 18 and five recorded intervals at which their patients returned to normal activities or sport. 16,21,26,27,29 Patients returned to sport by 4 weeks after their initial injury in most studies, and in one study 95% of patients returned to normal activities at 2 weeks after their initial injury. 26 Interestingly, there were no refractures recorded in any of these studies.…”

Section: Scoping Reviewmentioning

confidence: 97%

“…Twenty-two publications were included for data extraction (Figure 1). Sixteen studies 6,8,16,[18][19][20][21][22][23][24][25][26][27][28][29][30] related to specific fractures (Table 5), while six studies 14,[31][32][33][34][35] made general recommendations (Table 6).…”

Section: Scoping Reviewmentioning

confidence: 99%

“…18 One study only recorded RTS as time after cast removal; however, the casting time was variable among patients, so RTS time from initial injury could not be calculated. 29 Distal radius complete metaphyseal fractures. Two articles made general recommendations for RTS after complete distal radius fractures, 6,8 while two review articles recommended RTS at 5-8 weeks 18 and 8-10 weeks, respectively.…”

Section: Scoping Reviewmentioning

confidence: 99%

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Return to sport after forearm fractures in children: A scoping review and survey

Bhanushali

Bright

et al. 2023

Journal of Children's Orthopaedics

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Purpose: A common question faced by clinicians is when a child may return to sport after treatment for a pediatric forearm fracture. There are few published recommendations and fewer supported by evidence. The aims of this study were to summarize existing published recommendation for return to sport after pediatric forearm fractures and to conduct a survey to determine usual clinical recommendations. Methods: A scoping review was performed on Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar in accordance with the Joanna Briggs Institute guidelines. In addition, 64 orthopedic surgeons were anonymously surveyed asking for recommendations regarding return to sport after pediatric forearm fractures. Participants were to assume children were 9 years old and played a sport with an average risk of forearm injury. Results: Twenty-two publications for return to sport were retrieved. Children with distal radius buckle fractures safely commonly returned to sport by 4 weeks after initial injury, while survey respondents recommended over 6 weeks. Survey respondents valued fracture stability the highest when making return to sport recommendations. Children with simple, metaphyseal, single-bone fractures were usually allowed to return to sport at 8–10 weeks post-injury. Diaphyseal and complete fractures were prescribed longer return to sport intervals. Australian respondents also prescribed longer return to sport intervals. Conclusion: Children with distal radius buckle fractures may return to sport by 4 weeks after initial injury, sooner than recommended. Published recommendations remain limited for other fractures. However, our survey suggests children with simple, metaphyseal, single-bone fractures may return to sport at 8–10 weeks. Children with diaphyseal and complete fractures should abstain from sport for longer than metaphyseal and greenstick fractures, respectively. Level of evidence: level V

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“…18 One study only recorded RTS as time after cast removal; however, the casting time was variable among patients, so RTS time from initial injury could not be calculated. 29…”

Section: Resultsmentioning

confidence: 99%

Section: Scoping Reviewmentioning

confidence: 97%

Section: Scoping Reviewmentioning

confidence: 99%

Section: Scoping Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Return to sport after forearm fractures in children: A scoping review and survey

Bhanushali

Bright

et al. 2023

Journal of Children's Orthopaedics

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“…There is little consensus on the most adequate form of immobilization for a buckle fracture in the forearm and what palmar or dorsal angulation is still acceptable for a conservative therapeutic approach. 1,17,18 Furthermore, duration of immobilization is a constantly discussed topic. Some authors conclude that immobilization is merely pain relief and is not necessary for the healing of the fracture.…”

Section: Discussionmentioning

confidence: 99%

Do We Need a Strictly Lateral Radiograph for Fracture Management of Forearm Buckle Fractures in Children?

et al. 2023

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Objectives: Buckle fractures of the distal forearm are a common fracture entity in children treated conservatively. Diagnostics primarily include radiographs in 2 planes. Inadequate images may occur in the mostly very young patients. Therefore, additional lateral radiographs are often obtained to assess a possible angular tilt. The aim of this study is to investigate whether a strictly lateral x-ray image has an influence on fracture management.Methods: Seventy-three children with buckle fractures of the distal forearm were included in this retrospective analysis. All cases were analyzed by quality of radiographs, necessity to obtain an additional lateral radiograph, and what influence on fracture management resulted. Follow-up was performed 2 to 4 weeks after immobilization.Results: Thirty-five girls and 38 boys with a mean age of 7.16 years were included; 40 had fractured right and 33 had fractured left arms, respectively. Isolated distal radius fractures occurred in 48 cases, isolated distal ulna fractures in 6 cases, and both bones in 19 cases. Initial radiographic images were evaluated as inadequate in 25 cases. In each of those cases, an additional lateral image was obtained by fluoroscopy without resulting in an alternated fracture management protocol, which was chosen conservatively in each case and resulted in excellent clinical outcome at follow-up examination.Conclusions: Based on our results, the acquisition of additional lateral radiographs seems to be unnecessary in the diagnostic procedure of buckle fractures of the distal forearm, in case a possible palmar or dorsal angulation cannot be entirely assessed on the initial set of radiographs. An additional lateral image had no influence on fracture management, which was chosen conservatively in every case and led to excellent clinical results.Level of evidence: level III.

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Overwrapping Bivalved Casts: Does the Material Matter?

Karkenny,

Morris,

Smith

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Circumferential integrity of bivalved casts (cut twice longitudinally) can be restored by overwrapping with different materials. This study compared the mechanical properties of solid casts and bivalved casts overwrapped with semirigid fiberglass (SF), elastic bandages (EB), and rigid fiberglass (RF) using an overwrapped-bivalved cast-bone fracture (OBCBF) model. Methods: This study used an MTS Bionix Servohydraulic system to test properties of OBCBF models in 4 conditions: intact Control made of RF (not bivalved or overwrapped), a Rigid overwrapped model made of a Control bivalved and overwrapped with RF, a Semirigid overwrapped model made of a Control bivalved and overwrapped with SF, and an Elastic model made of a Control bivalved and overwrapped with EB. Constructs were tested in 4-point bending. Force-displacement curves (FDC) were generated to calculate load-at-critical-failure (LCF, angulation > 10 degrees = 6.6 mm vertical deformation) and stiffness. Results: Five controls and 30 OBCBF models with 3 overwrapped cast types were tested, with each overwrapped cast type tested with 2 orientations of the initial cast bivalve axis, yielding 7 conditions (Control, Rigid 0 degrees, Rigid 90 degrees, Semirigid 0 degrees, Semirigid 90 degrees, Elastic 0 degrees, Elastic 90 degrees). Mean LCF was: Rigid 90 degrees > Rigid 0 degrees > Control > Semirigid 0 degrees > Semirigid 90 degrees > Elastic 90 degrees > Elastic 0 degrees (P<0.0001). Mean stiffness was: Rigid 0 degrees > Rigid 90 degrees > Control > Semirigid 90 degrees > Semirigid 0 degrees > Elastic 0 degrees > Elastic 90 degrees (P<0.0001). Multiple comparisons indicated no significant difference between LCF and stiffness for Semirigid 0 degrees/90 degrees casts compared with Controls. Conclusions: Mechanical properties of overwrapped bivalved casts change depending on the materials used to overwrap, with higher LCF and stiffness when overwrapping with RF > SF > EB; however, mean comparisons indicate that rigid bivalved casts overwrapped with SF did not have significantly different mean stiffness and LCF from controls and other cast models. Clinical Relevance: This study compares the bending properties of a bivalved cast-construct overwrapped with different materials, providing basic science evidence for orthopaedic surgeons who have several choices of materials to overwrap bivalved casts.

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Using semi-rigid casts in the management of buckle fractures

Cited by 4 publications

References 0 publications

Return to sport after forearm fractures in children: A scoping review and survey

Return to sport after forearm fractures in children: A scoping review and survey

Do We Need a Strictly Lateral Radiograph for Fracture Management of Forearm Buckle Fractures in Children?

Overwrapping Bivalved Casts: Does the Material Matter?

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