title: The treatment of stable paediatric forearm fractures using a cast that may be removed at home: comparison with traditional management in a randomised controlled trial.
abstract: We investigated whether, in the management of stable paediatric fractures of the forearm, flexible casts that can be removed at home are as clinically effective, cost-effective and acceptable to both patient and parent as management using a cast conventionally removed in hospital. A single-centre randomised controlled trial was performed on 317 children with a mean age of 9.3 years (2 to 16). No significant differences were seen in the change in Childhood Health Assessment Questionnaire index score (p = 0.10) or EuroQol 5-Dimensions domain scores between the two groups one week after removal of the cast or the absolute scores at six months. There was a significantly lower overall median treatment cost in the group whose casts were removed at home (£150.88 (sem 1.90) vs £251.62 (sem 2.68); p < 0.001). No difference was seen in satisfaction between the two groups (p = 0.48).
authors.affiliation: Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: T W
authors.initials: TW
authors.lastname: Hamilton
authors.forename: L
authors.initials: L
authors.lastname: Hutchings
authors.forename: J
authors.initials: J
authors.lastname: Alsousou
authors.forename: E
authors.initials: E
authors.lastname: Tutton
authors.forename: E
authors.initials: E
authors.lastname: Hodson
authors.forename: C H
authors.initials: CH
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Wakefield
authors.forename: B
authors.initials: B
authors.lastname: Gray
authors.forename: S
authors.initials: S
authors.lastname: Symonds
authors.forename: K
authors.initials: K
authors.lastname: Willett
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002370:Casts, Surgical / Q000191:economics; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005592:Fracture Fixation / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life; D011885:Radius Fractures / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000191:economics / Q000601:surgery*
keywords: Cost analysis; Functional outcome; Home removable cast; Paediatric forearm fracture; RCT; Randomised controlled trial