title: Foam padding in casts accommodates soft tissue swelling and provides circumferential strength after fixation of supracondylar humerus fractures.
abstract: BACKGROUND
  Varying casting techniques are used after surgical treatment of pediatric supracondylar humerus fractures. The goals are to maintain fracture reduction, while accommodating soft tissue swelling and minimizing the risk of compartment syndrome.
  
  
  METHODS
  A retrospective chart review of consecutive patients aged 0 to 14 years who underwent surgical treatment of supracondylar humerus fractures over a 9½-year period at a pediatric trauma center was performed. A new method of casting, in which one half inch sterile foam is applied directly to the skin and overwrapped by circumferential fiberglass, is presented and compared with traditional casts.
  
  
  RESULTS
  A total of 541 consecutive patients were included. Foam had been used in 35% (190/541) of patients. Foam was used significantly more frequently in Gartland type 3 fractures (133/314 patients, 42%) than in type 2 fractures (57/227 patients, 25%) (P<0.001). Foam was also used more often in patients with preoperative neurovascular deficits (34/57, 60%) than in those without (156/484, 32%) (P<0.001). No patient in either group developed compartment syndrome postoperatively. Both patients in the study who required revision closed reduction and pinning were casted without foam, and one of these casts had been split. Reoperation was not associated with cast splitting (P=0.216) or foam use (P=0.543).
  
  
  CONCLUSIONS
  For postoperative immobilization of supracondylar humerus fractures we present a new method of placing foam directly on the skin, followed by circumferential fiberglass casting. This method offers the theoretical advantage of the strength of a circumferential cast, plus the benefit of allowing for swelling. Although the novel foam and cast combination was used in more severe fractures, results were comparable to traditional casts and may reduce the need for cast splitting.
  
  
  METHODS
  Therapeutic-Level III.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Seehausen
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
authors.forename: Deirdre D
authors.initials: DD
authors.lastname: Ryan
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000293:Adolescent; D002370:Casts, Surgical / Q000009:adverse effects / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D011482:Protective Devices / Q000639:trends*; D012086:Reoperation; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome