title: Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial.
abstract: BACKGROUND
  Minimally angulated fractures of the distal radius are common in children and have excellent outcomes. We conducted a randomized controlled trial to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function.
  
  
  METHODS
  We included 96 children 5 to 12 years of age who were treated for a minimally angulated (≤ 15°) greenstick or transverse fracture of the wrist between April 2007 and September 2009 at a tertiary care pediatric hospital. Participants were randomly assigned to receive either a prefabricated wrist splint or a short arm cast for four weeks. The primary outcome was physical function at six weeks, measured using the performance version of the Activities Scale for Kids. Additional outcomes included the degree of angulation, range of motion, grip strength and complications.
  
  
  RESULTS
  Of the 96 children, 46 received a splint and 50 a cast. The mean Activities Scale for Kids score at six weeks was 92.8 in the splint group and 91.4 in the cast group (difference 1.44, 95% confidence interval [CI] -1.75 to 4.62). Thus, the null hypothesis that the splint is less effective by at least seven points was rejected. The between-group difference in angulation at four weeks was not statistically significant (9.85° in the splint group and 8.20° in the cast group; mean difference 1.65°, 95% CI -1.82° to 5.11°), nor was the between-group differences in range of motion, grip strength and complications.
  
  
  CONCLUSIONS
  In children with minimally angulated fractures of the distal radius, use of a splint was as effective as a cast with respect to the recovery of physical function. In addition, the devices were comparable in terms of the maintenance of fracture stability and the occurrence of complications. (ClinicalTrials.gov trial register no. NCT00610220.).
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont. boutis@pol.net
authors.forename: Kathy
authors.initials: K
authors.lastname: Boutis
authors.forename: Andrew
authors.initials: A
authors.lastname: Willan
authors.forename: Paul
authors.initials: P
authors.lastname: Babyn
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.forename: Andrew
authors.initials: A
authors.lastname: Howard
mesh_terms: D000203:Activities of Daily Living; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011885:Radius Fractures / Q000503:physiopathology / Q000628:therapy*; D013165:Splints; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
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