Is Univalving or Bivalving of Long Arm Casts for Forearm Fractures Necessary?
| Status: | Recruiting |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 3 - 12 |
| Updated: | 10/14/2017 |
| Start Date: | January 2013 |
| End Date: | January 2017 |
| Contact: | Mark Lee, MD |
| Email: | Mlee01@connecticutchildrens.org |
| Phone: | 860-545-9100 |
This study aims to examine the need for univalve or bivalve splitting of casts in pediatric
patients with forearm fractures following closed reduction and cast application in a
randomized, prospective fashion.
patients with forearm fractures following closed reduction and cast application in a
randomized, prospective fashion.
Following cast application, little is known regarding the need to split the cast, either in a
univalve (a split along a single side of the cast) or bivalve (a split along both sides of
the cast) fashion. Theoretically, the splitting of the cast allows for expansion and soft
tissue swelling. However, review of the literature yields a paucity of evidence demonstrating
the efficacy of splitting a cast. In a study by Nietosvaara et. al, a retrospective
examination of 109 pediatric patients initially treated with closed cylindrical casting for
closed forearm fractures were evaluated. Of these 109 patients, one-sixth required the
initial cast to be split, trimmed, or removed secondary to post-traumatic swelling.
However, the splitting of a cast is not without risks in itself. Once the initial swelling
dissipates, a univalved or bivalved cast can become excessively loose. This loosening has
been associated with a loss of reduction. If the loss or reduction is substantial, it may
require a re-reduction or operation to correct. In addition, with every use of the cast saw a
patient is placed at risk for iatrogenic cast saw injury. Thermal burns and abrasions from
cast saws can cause lifelong emotional and physical scars for a patient. They can also be an
inciting event for litigation against the hospital and or provider, with settlements
averaging greater than $12,000 per centimeter of cast saw injury.
univalve (a split along a single side of the cast) or bivalve (a split along both sides of
the cast) fashion. Theoretically, the splitting of the cast allows for expansion and soft
tissue swelling. However, review of the literature yields a paucity of evidence demonstrating
the efficacy of splitting a cast. In a study by Nietosvaara et. al, a retrospective
examination of 109 pediatric patients initially treated with closed cylindrical casting for
closed forearm fractures were evaluated. Of these 109 patients, one-sixth required the
initial cast to be split, trimmed, or removed secondary to post-traumatic swelling.
However, the splitting of a cast is not without risks in itself. Once the initial swelling
dissipates, a univalved or bivalved cast can become excessively loose. This loosening has
been associated with a loss of reduction. If the loss or reduction is substantial, it may
require a re-reduction or operation to correct. In addition, with every use of the cast saw a
patient is placed at risk for iatrogenic cast saw injury. Thermal burns and abrasions from
cast saws can cause lifelong emotional and physical scars for a patient. They can also be an
inciting event for litigation against the hospital and or provider, with settlements
averaging greater than $12,000 per centimeter of cast saw injury.
Inclusion Criteria:
- A closed isolated radial and/or ulna fracture of the forearm inclusive of metaphyseal
and/or shaft level fractures.
- Forearm fractures that require closed reduction (with or without conscious sedation)
- Patients between the ages of 3 and 12 years old
Exclusion Criteria:
1. Specific exclusions
- Age less than 3 or greater than 12
- Patients presenting with an associated neurological or vascular injury caused by
the fracture
- Patients presenting with an open fracture
- Patients requiring operative treatment following the initial fracture evaluation
- Ipsilateral upper extremity fracture
- Patients intubated or with a pre-existing condition that prevents them from
verbalizing symptoms of discomfort
2. Generic exclusion: "Subjects not meeting all inclusion criteria."
We found this trial at
1
site
282 Washington St
Hartford, Connecticut 06106
Hartford, Connecticut 06106
(860) 545-9000
Principal Investigator: Mark Lee, MD
Phone: 860-284-0208
Connecticut Children's Medical Center Connecticut Children’s Medical Center is a nationally recognized, 187-bed not-for-profit children’s...
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