title: Conversion to below-elbow cast after 3 weeks is safe for diaphyseal both-bone forearm fractures in children.
abstract: BACKGROUND
  It is unclear whether it is safe to convert above-elbow cast (AEC) to below-elbow cast (BEC) in a child who has sustained a displaced diaphyseal both-bone forearm fracture that is stable after reduction. In this multicenter study, we wanted to answer the question: does early conversion to BEC cause similar forearm rotation to that after treatment with AEC alone?
  
  
  METHODS
  Children were randomly allocated to 6 weeks of AEC, or 3 weeks of AEC followed by 3 weeks of BEC. The primary outcome was limitation of pronation/supination after 6 months. The secondary outcomes were re-displacement of the fracture, limitation of flexion/extension of the wrist and elbow, complication rate, cast comfort, complaints in daily life, and cosmetics of the fractured arm.
  
  
  RESULTS
  62 children were treated with 6 weeks of AEC, and 65 children were treated with 3 weeks of AEC plus 3 weeks of BEC. The follow-up rate was 60/62 and 64/65, respectively with a mean time of 6.9 (4.7-13) months. The limitation of pronation/supination was similar in both groups (18 degrees for the AEC group and 11 degrees for the AEC/BEC group). The secondary outcomes were similar in both groups, with the exception of cast comfort, which was in favor of the AEC/BEC group.
  
  
  CONCLUSIONS
  Early conversion to BEC cast is safe and results in greater cast comfort.
authors.affiliation: Department of Orthopaedic Surgery , Erasmus Medical Center , Rotterdam.
authors.forename: Joost W
authors.initials: JW
authors.lastname: Colaris
authors.forename: Jan Hein
authors.initials: JH
authors.lastname: Allema
authors.forename: L Ulas
authors.initials: LU
authors.lastname: Biter
authors.forename: Max
authors.initials: M
authors.lastname: Reijman
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: Rolf M
authors.initials: RM
authors.lastname: Bloem
authors.forename: Albert J H
authors.initials: AJ
authors.lastname: Kerver
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
mesh_terms: D000293:Adolescent; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D004550:Elbow; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011403:Pronation / Q000502:physiology; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013484:Supination / Q000502:physiology; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*