Randomized Trial of Casting Techniques for Displaced Forearm Fractures

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.

Patients with a displaced distal radius or mid-diaphyseal forearm fracture requiring closed reduction will be immobilized in a bivalved cast

Patients with a displaced distal radius or mid-diaphyseal forearm fracture requiring closed reduction will be immobilized in a circumferential cast

The number of participants that experienced radiographic loss of reduction by four weeks post-randomization.

The number of participants that experienced compartment syndrome or neurovascular compromise, saw burn and/or laceration within four weeks post-randomization.

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