Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial.
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.).
Boutis
Kathy
K
Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont. boutis@pol.net
Willan
Andrew
A
Babyn
Paul
P
Goeree
Ron
R
Howard
Andrew
A
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
J Clin Epidemiol. 1996 Oct;49(10):1097-101
8826988
Am Fam Physician. 2009 Jan 1;79(1):16-22
19145960
J Pediatr Orthop. 1995 Mar-Apr;15(2):244-53
7745102
J Bone Joint Surg Am. 2006 Jan;88(1):1-8
16391243
Pediatrics. 2006 Mar;117(3):691-7
16510648
Control Clin Trials. 1984 Jun;5(2):97-105
6744888
J Pediatr Orthop. 2007 Oct-Nov;27(7):831-3
17878794
Phys Ther. 1987 Dec;67(12):1867-72
3685114
Pediatr Emerg Care. 2008 Feb;24(2):65-70
18277840
Pain. 1990 May;41(2):139-150
2367140
Pain. 2001 Aug;93(2):173-183
11427329
J Clin Epidemiol. 2000 Feb;53(2):125-37
10729684
CJEM. 2007 Jan;9(1):9-15
17391594
Am J Orthop (Belle Mead NJ). 2005 Jan;34(1):43-6
15707139
Biometrics. 1977 Dec;33(4):593-602
588654
J Bone Joint Surg Br. 2001 Apr;83(3):388-90
11341425
Injury. 2005 Feb;36 Suppl 1:A3-11
15652934
Nurs Stand. 2009 Aug 26-Sep 1;23(51):49-56; quiz 57
19753778
Arch Phys Med Rehabil. 1995 Oct;76(10):913-8
7487430
Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004576
18425904
Phys Ther. 1988 Nov;68(11):1676-8
3186793
J Pediatr Orthop B. 2003 Mar;12(2):109-15
12584495
Stat Med. 1990 Dec;9(12):1447-54
2281232
J Bone Joint Surg Br. 2001 Nov;83(8):1173-5
11764434
Clin Orthop Relat Res. 1980 Jan-Feb;(146):175-83
7371246
Acta Orthop Scand. 1989 Feb;60(1):63-5
2929298
J Pediatr Orthop. 2003 Nov-Dec;23(6):788-90
14581784