September 10, 2012

CHICAGO — Bivalved casts are as safe and effective as circumferential casts for displaced forearm fractures in children, according to a study presented at the American Society for Surgery of the Hand 2012 Annual Meeting.

“We found no differences in measures of alignment, re-manipulation, surgery rates or complications,” study presenter Donald S. Bae, MD, said. “About one-fifth of the patients lost reduction and went on to require re-manipulation or surgical treatment. In addition, the average cast index was 0.8, which is higher and therefore less optimal than established benchmarks. This highlights the need for continued education and training of the art of cast application.”

Donald S. Bae

Bae and colleagues randomized 205 children with a mean age of 10 years who underwent treatment for displaced forearm fractures into bivalved (104 patients) and circumferential (101 patients) casting groups. The investigators recorded loss of reduction, the need for re-manipulation or surgery, associated compartment syndrome complications and cast saw injury or neurovascular compromise.

The investigators found no significant differences in mean angulation, loss of reduction or surgical treatment between the groups. Mean angulation of fractures in the radius and ulna improved from 12.7° and 22.1°, respectively at time of fracture to 2.1° and 4.4° after closed reduction. The cast index was 0.79 for the bivalved group and 0.81 in the circumferential group. The researchers switched nine patients to bivalved casts from circumferential casts after pain or swelling. One bivalve patient had a cast saw injury, and three bivalved patients had transient neurologic abnormalities.

Overall, 39 patients had loss of reduction and 42 needed re-manipulation or surgical reduction and fixation, but none of the patients developed compartment syndrome.

“Future investigation will involve assessment of the risk factors for instability, evaluate the utility and cost efficacy of clinical visits and continue to assess cast application quality,” Bae said.

Reference:

Bae DS, Valim C, Connell P, et al. Circumferential vs bivalved cast immobilization for displaced forearm fracture: A randomized clinical trial to assess safety and efficacy. Paper #56. Presented at the American Society for Surgery of the Hand 2012 Annual Meeting. Sept. 6-8. Chicago.