None listed
Conditions
Brief summary
This study will be a randomised controlled trial aiming to compare traditional Plaster of Paris (POP) cast versus synthetic cast for management of patients with simple wrist fractures who present to Monash Health emergency departments (ED). We hypothesize that if synthetic casts are applied in the ED in the first instance, although this material is more expensive than POP, this would eliminate the need for further cast changes at the Fracture Clinic review (usually 2/52 post injury). Therefore this intervention would reduce cost and time for the organisation overall. The primary outcome measure will be total number of cast changes until immobilisation by cast is no longer required. Secondary outcomes will include cost effectiveness and patient satisfaction. 110 participants will be recruited to the study between July 2021 to January 2022. Evidence gained from this study will contribute to future treatment of wrist fractures in the ED. It would reduce the cost to the healthcare system and demand on Fracture Clinic and also improve patient satisfaction and comfort. This practice may be translated into other health care networks in Australia and worldwide.
Interventions
Intervention group
A synthetic cast will be applied to patients who are admitted into the study and allocated to the intervention group. This will be applied on the initial ED presentation and the patient will be discharged with a referral for Fracture clinic follow-up as per normal Monash Health protocol. At this appointment the Fracture clinic doctors will review the plaster and monitor the progress of the fracture healing as per standard care. The synthetic cast will be changed if any issues
Intervention group A synthetic cast will be applied to patients who are admitted into the study and allocated to the intervention group. This will be applied on the initial ED presentation and the patient will be discharged with a referral for Fracture clinic follow-up as per normal Monash Health protocol. At this appointment the Fracture clinic doctors will review the plaster and monitor the progress of the fracture healing as per standard care. The synthetic cast will be changed if any issues arise with it, or it will remain in-situ for the duration of the immobilisation period (generally 6 weeks). We plan to work out the average time it takes to apply the cast when we do the training of their applications (approximately 20 casts). We would estimate it would take about 10 min
Sponsors
Casey Hospital
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
5 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients to be included must meet the following criteria: 1. Paediatric including and over the age of 5 years of age and adults 2. Fracture acutely sustained (previous 72 hours), undisplaced forearm fracture (including distal radius and/or ulna [epiphysis/metaphysis] 3. Below elbow circumferential casting is the management in accordance to Monash Health Orthopaedic recommendations. 4. Ongoing conservative management is planned 5. Ongoing management expected to take place within Monash Health (Monash Emergency and Monash Orthopaedic units) 6. Able to give informed consent.
Exclusion criteria
Patients will be excluded if they have any of the following conditions: 1. Compound (open) fracture 2. Significant swelling and/or neurovascular compromise such that initial backslab (rather than circumferential casting) is recommended. 3. Isolated proximal forearm fractures such as radial head/neck, olecranon or coronoid process fractures of ulna(displaced or undisplaced). 4. Any forearm fracture or fracture-dislocation for which operative management is recommended (acute or delayed). 5. Inability to understand the study explanation/requirements for any reason (e.g. language difficulties, abnormal/reduced cognitive state). 6.Adequate circumferential cast already in place (from GP or non-Monash referring hospital). 7.Fracture requiring surgical stabilisation
Outcome results
None listed