Onderarmgips bij distale fracturen van radius én ulna*

Objective

A comparison of above-elbow cast (AEC) with below-elbow cast (BEC) for the treatment of minimally-displaced metaphyseal both-bone fractures in children.

Design

Randomized controlled study (Clinical Trials.gov NCT00397995).

Methods

In 4 Dutch hospitals, children (< 16 years) with metaphyseal both-bone fractures in whom reposition was not needed were randomized between treatment of 4 weeks with an above-elbow cast and treatment of 4 weeks with a below-elbow cast. The primary outcome measure was reduced pronation and supination measured 6 months after the initial trauma. The secondary outcome measures were comfort of the cast, reduced flexion or extension of wrist or elbow, complications, limitations in daily life and evaluation of X-rays.

Results

A group of 35 children were treated with below-elbow casts while 31 children received above-elbow casts. All children were assessed after a follow-up averaging 7.0 months (range: 5.0-11.6). Both groups had comparable limitation in pronation and supination: 4.4 degrees (SD: 5.8) after treatment with a below-elbow cast and 5.8 degrees (SD: 9.8) after an above-elbow cast. Children treated with a below-elbow cast found the cast considerably more comfortable (visual analogue scale (VAS): 5.6 (SD: 2.7) vs. 8.4 (SD: 1.4)) and required significantly fewer days of assistance in dressing (8.2 vs. 15.1). Six complications occurred in the group of children treated with a below-elbow cast, while 14 complications occurred in the other group. Results for the remaining outcome measures were comparable between the two groups.

Conclusion

Children with minimally-displaced metaphyseal both-bone fractures can safely be treated with a below-elbow cast.

Conflict of interest: financial remuneration has been declared (see www.ntvg.nl, search at A5332; click on ‘Belangenverstrengeling’(‘Conflict of interest’). Financial support for this article: none declared.