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Archives of Disease in Childhood - Education and Practice 2006;91:ep92
Copyright © 2006 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.

EVIDENCE-BASED MEICINE

Below the elbow casts were as effective as above the elbow casts for maintaining reduction of forearm fractures in children

Bohm ER, Bubbar V, Yong-Hing K, et al. Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am 2006;88:1–8.[Abstract/Free Full Text]

In children with a closed fracture of the distal third of the forearm, are below the elbow casts as effective as above the elbow casts?

Clinical impact ratings GP/FP/Primary care ****{star}{star}{star} Orthopaedics ******{star} Emergency medicine ****{star}{star}{star} Paediatrics ***{star}{star}{star}{star}

Keywords: casts (surgical); elbow; forearm injuries; fractures (closed); radius fractures; ulna fractures

The first 150 words of the full text of this article appear below.

METHODS


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Design: randomised controlled non-inferiority trial.


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Allocation: {concealed*}{dagger}.


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Blinding: blinded (outcome assessors).*


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Follow up period: 18 weeks.


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Setting: tertiary care hospital in Saskatoon, Saskatchewan, Canada.


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Patients: 117 children 4–12 years of age who presented with a closed fracture of the distal third of the forearm requiring reduction. Children with open factures or Salter Harris type III or IV fractures were excluded.


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Intervention: below the elbow (n = 46) or above the elbow (n = 56) cast was applied after closed reduction of the fracture. Reduction was done under conscious sedation in the emergency department within 4 hours, or under general anaesthesia in the operating room within 24 hours. Follow up visits were done every week for 3 weeks, and the cast was removed after 6 weeks.


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Outcomes: immobilisation of the fracture as determined by reangulation in the cast and by the need for remanipulation. The study had >90% power . . . [Full text of this article]

William J Gillespie, FRACS

Hull York Medical School
Hull, UK


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