Randomized Trial of Casting Techniques for Displaced Forearm Fractures

Randomized Trial of Bivalved and Circumferential Casting for Displaced Forearm Fractures in Children

It is recognized that fractures of the distal radius and forearm occur in approximately one in 100 children and adolescents every year. Though closed manipulation and cast immobilization of displaced injuries is the mainstay of treatment in the majority of cases, the optimal type of cast remains debatable. Though well-molded casts theoretically provide the best ability to maintain fracture alignment, risks of circumferential immobilization in acute injuries include neurovascular compromise. Splitting, or bivalving, casts may reduce these risks, but the effect on fracture stability is unknown. The proposed investigation seeks to address the simple question of whether circumferential or bivalved casts provide the best outcomes.

Inclusion Criteria:

• Displaced distal radius or mid-diaphyseal forearm fracture
• fracture requires closed reduction and cast immobilization
• Age 4-16 years
• Skeletally immature

Exclusion Criteria:

• Failed closed reduction
• Acute fracture > 1 week old
• Refracture injury
• Fracture requires surgical treatment
• Significant soft tissue swelling
• Associated neurovascular compromise
• Plastic deformation injuries