Abstract
Background Fractures of the forearm are the most common fractures in children. Various methods
of cast immobilization have been recommended. Currently, there is still controversy
regarding the optimal method of treatment, especially regarding the need for cast
splitting.
Methods We conducted a single-center randomized and controlled trial between June 2008 and
September 2009. Children younger than 16 years presenting to the emergency department
with a closed fracture of the forearm needing reduction were eligible for random assignment
to immobilization in a closed or split circumferential semirigid cast. The primary
outcome was the incidence of cast-related soft-tissue problems such as compartment
syndrome, neurovascular compromise, saw burns, or skin breakdown. The secondary outcome
was fracture stability.
Results During this period, 100 patients were randomly assigned to one of the two procedures
and analyzed. Follow-up was completed in 99 patients. No compartment syndrome was
observed in either group. Moderate skin breakdown (< 2 cm2) occurred in two patients, one in the closed cast and one in the split cast group.
Secondary splitting was necessary in one patient because of a reversible lymphedema.
Significant secondary displacement of the fracture was slightly more common in the
split group (5 of 50 patients [10%] vs. 4 of 49 patients [8%] in the closed cast group)
without reaching statistical significance.
Conclusions No significant difference in the incidence of cast-related problems was observed
between the groups. Fracture stability was comparable in both groups. We suggest that
closed circumferential semirigid casts are a safe and effective immobilization technique
for fractures of the forearm in children and splitting can be omitted.
Keywords
forearm fractures in children - closed versus split cast - soft-tissue problems -
fracture stability
