CORA ABSTRACT #I - 2

A RANDOMIZED CONTROLLED TRIAL OF ABOVE VS BELOW ELBOW CASTS IN PAEDIATRIC DISTAL THIRD FOREARM FRACTURES

INTERIM RESULTS

V. Bubbar

E. Bohm

K. Yong-Hing

A. Dzus

The cast applied after reduction of paediatric distal third forearm fractures is controversial. Both above and below elbow casts are used. The remanipulation rate in the literature is 7.5% for above elbow casts and 2.5% for below elbow casts.

We are undertaking a prospective, randomized controlled trial of children treated with either above or below elbow casts. Inclusion criteria were children aged 4 to 12 years, with a closed distal third forearm fracture requiring reduction. Outcome measures were remanipulation rates, loss of reduction, and cast complications.

Eighty-one patients have been suitably randomized. Thirty-three of 42 children in the above elbow group had both bone fractures compared to 22 of 39 in the below elbow group. All remaining children in both groups had radius only fractures. There were no differences between the two groups in terms of average initial or post-reduction angulation, the amount of fracture displacement during cast wear, and cast complications. Remanipulation rates in the two groups were not statistically different, even when analyzed by fracture type. The average cast index in fractures that lost reduction was 0.74 and 0.71 in fractures that did not (p=0.08), regardless of cast type.

Our interim results do not show any difference in above or below elbow casts for distal third fractures of the radius. We feel that a well moulded cast with an index of £0.70 is important.