Comparison of two methods of immobilising torus fractures of the distal forearm

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AIM: To determine patient and family preferences for immobilisation of undisplaced buckle (greenstick) type fractures of the forearm near to the wrist (distal forearm). BACKGROUND: In the group of children who sustain fractures (breaks) of the forearm near to the wrist, which are undisplaced the mode and length of immobilisation in plaster has been variable. It has been shown that adequate treatment is to immobilize the arm for a two week period, remove the plaster cast then reassess the fracture site for tenderness. The treatment is then either to mobilise if there is minimal tenderness or to re-plaster for a further 1-2 weeks if there is still significant pain. The method of immobilising these injuries has traditionally been in a full, encircling plaster cast, which requires splitting for removal. Another method that has gained popularity recently is the plaster slab (half cast), fashioned and moulded to one side of the child’s forearm and wrist and held in place with a crepe bandage. The functional outcome anecdotally appears to be the same with these two techniques, but the patient preference and comfort have never been investigated. HYPOTHESIS: That plaster slab treatment of buckle fractures of the distal forearm is at least as acceptable to patients as full plaster casting, and that return to function will not be delayed. PROJECT DESIGN: this is to be a prospective randomised study of two techniques of immobilisation of buckle fractures of the distal forearm in children. All children < 17 years of age, with an undisplaced fracture of the radius or ulna, presenting to the Emergency Department of the Royal Children’s Hospital will be enrolled into the study and randomised into either application of a full plaster cast or a plaster slab (half cast) Parents will be asked to keep a daily diary of analgesia use, child complaints or perceived problems with the plaster. Follow up will be in the Emergency Department by one of the two investigators at 2 weeks post injury. At this time a patient and parent satisfaction questionnaire will be completed, the plaster will be removed and the forearm fracture reassessed. If there is minimal or no tenderness the patient will be allowed to mobilise and return to normal function. If there is pain the plaster, or plaster slab, will be replaced and review in a further 2 weeks will occur. RELEVANCE: This research is relevant to current clinical management of patients with the described injuries as it will provide information as to the most acceptable immobilisation from the patients and families point of view. It will also establish the time taken for different immobilisation techniques to return the children to full function. These results should guide future treatment of these injuries, both in the hospital and in general practice clinics.

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