AAOS 2016: Removable long-arm soft cast in non-displaced pediatric elbow fracture

Study Type: Therapy
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
100 children between the ages of 2-10 years, with a closed, non-displaced, type 1 supracondylar humeral fracture or a closed, acute elbow injury with a positive posterior fat pad sign were randomly assigned a standard long-arm hard, fiberglass cast or a soft, removable long-arm fiberglass cast. The purpose of this study was to compare the use of the soft removable cast to the traditional hard cast in terms of fracture displacement, range of motion, pain, and patient satisfaction. The results displayed Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
A specific regimen of immobilization for non-displaced elbow fractures in the pediatric population has yet to be well delineated. The use of soft casts that are able to be removed by the patient's parent may represent a viable and attractive alternative to traditional hard casts, which require a follow-up appointment with a cast-saw for removal. Thus, the present study was conducted to compare outcomes in the pediatric population between these casting methods.
What was the principal research question?
In paediatric elbow fractures, how do the results of a soft, removable long-arm cylinder cast compare to a traditional long-arm fibreglass cast in terms of fracture displacement, range of motion, pain, and satisfaction?
Population: 100 children aged 2-10 years, with either a non-displaced, type 1 supracondylar humeral fracture (SCHF) or a closed, acute elbow injury with a positive posterior fat pad sign.
Intervention: Soft cast group: Patient's arm was immobilized with a long-arm, soft fiberglass cast. After 4 weeks, the cast was removed by the patient's parents (n=50)
Comparison: Hard cast group: Patient's arm was immobilized with a a long-arm, traditional hard fiberglass cast. After 4 weeks, the cast was removed using a cast saw (n=50)
Outcomes: Outcomes included fracture displacement and/or angulation, recovery of range of motion, elbow pain, and patient satisfaction.
Methods: RCT
Time: Follow-up was conducted at up to 8 weeks.
What were the important findings?
CONTENT IS LOCKED
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Robert Eilert
June 30, 2016
Orthopaedic Surgeon - United States
Immobilization is. The effect of casting is unchanged. Change is for practitioner. Parents routinely ask questions about rehab and return to activity at time of cast removal. The cast is protection. The body heals. Admirer and user of soft cast, but enjoy relating to parents and children.