title: Below-elbow cast for metaphyseal both-bone fractures of the distal forearm in children: a randomised multicentre study.
abstract: BACKGROUND
  Minimally displaced metaphyseal both-bone fractures of the distal forearm in children are often treated with an above-elbow cast (AEC). Treatment with a below-elbow cast (BEC) could give more comfort, but might lead to fracture displacement reducing pronation and supination. Because this has not been systematically investigated, we set up a randomised multicentre study. The purpose of this study was to find out whether BEC causes equal limitation of pronation and supination but with higher comfort level, compared with AEC.
  
  
  METHODS
  In four hospitals, consecutive children aged<16 (mean 7.1) years with a minimally displaced metaphyseal both-bone fracture of the distal forearm were randomised to 4 weeks BEC (n=35) or 4 weeks AEC (n=31). Primary outcome was limitation of pronation and supination 6 months after initial trauma. The secondary outcomes were cast comfort, limitation of flexion/extension of wrist/elbow, complications, cosmetics, complaints, and radiological assessment.
  
  
  RESULTS
  A group of 35 children received BEC and 31 children received AEC. All children attended for the final examination at a mean follow-up of 7.0 months (range 5.0-11.6 months). Limitation of pronation and supination 6 months after initial trauma showed no significant difference between the two groups [4.4° (± 5.8) for BEC and 5.8° (± 9.8) for AEC]. Children treated with BEC had significantly higher cast comfort on a visual analogue scale [5.6 (± 2.7) vs. 8.4 (± 1.4)] and needed significantly less help with dressing (8.2 days vs. 15.1 days). Six complications occurred in the BEC group and 14 in the AEC group. Other secondary outcomes were similar between the two groups.
  
  
  CONCLUSIONS
  Children with minimally displaced metaphyseal both-bone fractures of the distal forearm should be treated with a below-elbow cast.
authors.affiliation: Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. joostcolaris@hotmail.com
authors.forename: Joost W
authors.initials: JW
authors.lastname: Colaris
authors.forename: L Ulas
authors.initials: LU
authors.lastname: Biter
authors.forename: Jan Hein
authors.initials: JH
authors.lastname: Allema
authors.forename: Rolf M
authors.initials: RM
authors.lastname: Bloem
authors.forename: Cees P
authors.initials: CP
authors.lastname: van de Ven
authors.forename: Mark R
authors.initials: MR
authors.lastname: de Vries
authors.forename: Albert J H
authors.initials: AJ
authors.lastname: Kerver
authors.forename: Max
authors.initials: M
authors.lastname: Reijman
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
mesh_terms: D002370:Casts, Surgical; D002648:Child; D004550:Elbow; D005260:Female; D017102:Fracture Healing; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011403:Pronation; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012399:Rotation; D013484:Supination; D011795:Surveys and Questionnaires; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*