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Waterproof Casts For The Management Of Upper Limb Fractures In Children
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August 2025
Waterproof Casts For The Management Of Upper Limb Fractures In Children
Study Type:Therapy
OE Level Evidence:1
Journal Level of Evidence:1
Waterproof casts for the management of upper limb fractures in children : a systematic review and meta-analysis.
Bone Joint J . 2025 Jun 1;107-B(6):587-594.Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
Five studies including 390 children with upper limb fractures were included in this systematic review and meta-analysis comparing waterproof casts vs. standard non-waterproof casts. Pooled outcomes of interest included comfort, itchiness, child and parent satisfaction, functional performance (ASK-P), return to activities, and complication rates. Waterproof casts significantly improved comfort, itchiness, and satisfaction, and yielded higher functional scores on the ASK-P. There were no significant differences in pain, skin complications, or loss of fracture reduction. These findings suggest waterproof casts are a safe and more comfortable alternative with improved satisfaction and function in children.
Publication Funding Details
Funding
Not funded
Funding Details
The authors received no financial or material support for the research, authorship, and/or publication of this article.
Disclosures
Royalties, Consultant, Other, Grants, Personal Fees
Why was this study needed now?
Upper limb fractures are the most common pediatric fractures, and most are treated conservatively with casts. However, standard casts can limit hygiene, bathing, and overall satisfaction. Waterproof casts, though potentially beneficial, are underused due to concerns over cost, stability, and limited evidence on outcomes. This study addresses the lack of high-quality comparative evidence to evaluate whether waterproof casts offer measurable clinical advantages over standard options in children.
What was the principal research question?
In children with upper limb fractures, does treatment with waterproof casts, improve functional outcomes, comfort, and satisfaction compared to standard non-waterproof casts, without increasing complication rates?
What were the important study characteristics?
Population
390
Total Sample Size
Children with various types of upper limb fractures, including displaced forearm fractures, distal radial fractures, and supracondylar fractures, managed conservatively with casting.
Intervention
Waterproof Cast
Children treated with waterproof casts, including swim casts, synthetic liners (e.g., DeltaDry, hybrid mesh), or waterproof-padded fiberglass casts that allow immersion in water.
Intervention
Cast Immobilization
Children treated with standard non-waterproof casts, such as traditional cotton-lined plaster or fiberglass casts, instructed to remain dry throughout immobilization.
Outcomes
Normalized comfort scale
Comfort
Normalized itchiness scale
Comfort
Normalized heat and sweatiness scale
Comfort
Incidence of swimming
Physical Performance
Incidence of skin complication
Adverse events
Normalized satisfaction scale
Satisfaction
Normalized Pain Scale
Pain
Incidence of unscheduled hospital visit
Adverse events
Methods
Meta-analysis
Time
Final follow-up
Outcomes: Adverse events, Comfort, Pain, Physical Performance, Satisfaction
Risk of Bias
Confidence in the results: Critically Low
Risk of Bias
Yes
Partial Yes
No
Protocol registered before commencement of the review
Adequacy of the literature search
Justification for excluding individual studies
Risk of bias from individual studies being included in the review
Appropriateness of meta-analytical methods
Consideration of risk of bias when interpreting the results of the review
Assessment of presence and likely impact of publication bias
Confidence in the results: Critically Low
What were the important findings?
Significantly Better
No Difference
Significantly Better
Cast Immobilization
Waterproof Cast
MD: Mean Difference; SMD: Standardized Mean Difference; OR: Odds Ratio, RR: Risk Ratio; CI: Confidence Interval
What should I remember most and how will this affect the care of my patients?
Waterproof casts may provide superior comfort, reduce itchiness, and improve satisfaction and function without increasing complications in children with upper limb fractures. These findings support the clinical adoption of waterproof casting as a safe and more patient-friendly alternative. However, the small sample sizes, high risk of bias, and lack of cost-effectiveness data limit the generalizability of the findings.
DISCLAIMER:
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
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