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Original Article · Open access

A comparison of two immobilization methods in the conservative treatment of pediatric distal forearm fractures: Long arm cast versus single sugar-tong splint

Cite this article

Ali Engin Daştan

Department of Orthopedics and Traumatology, Medicine Faculty of Ege University, Izmir, Türkiye

ORCID: 0000-0003-3637-8550

Arman Vahabi

Department of Orthopedics and Traumatology, Medicine Faculty of Ege University, Izmir, Türkiye

Omar Aljasim

Department of Orthopedics and Traumatology, Medical Park Gebze Hospital, Izmit, Türkiye

ORCID: 0000-0001-7193-0326

Bünyamin Kılıçlı

Department of Orthopedics and Traumatology, Medicine Faculty of Ege University, Izmir, Türkiye

ORCID: 0000-0002-8638-074X

Levent Küçük

Department of Orthopedics and Traumatology, Medicana International Hospital, Izmir, Türkiye

ORCID: 0000-0001-7251-9512

Erhan Coşkunol

Department of Orthopedics and Traumatology, Medicine Faculty of Ege University, Izmir, Türkiye

ORCID: 0000-0003-2737-3715

Abstract

Objectives: The aim of this study was to compare the results of single sugar-tong splint (SSTS) and long arm cast (LAC) as an immobilization method in pediatric distal forearm fractures.

Patients and methods: Between January 2016 and December 2019, a total of 186 pediatric patients (143 males, 43 females; mean age: 10.3±3 years; range, 4 to 15 years) with distal forearm fractures were retrospectively analyzed. The patients were divided into two groups according to the immobilization method: SSTS group (n=74) and LAC group (n=112). All patients were evaluated at the time of admission, immediately after the reduction, and at one, two, and four weeks. Sagittal and coronal plane angulations and translation percentages of the radius at each visit were calculated. Alterations in coronal angle, sagittal angle, sagittal translation and coronal translation were calculated by subtracting the measurements after reduction from the measurements at four weeks.

Results: Both groups were comparable in terms of demographic characteristics, fracture localization, and side of injured extremity. There was a statistically significant difference only in the sagittal angulations in the first (LAC: 4.7; SSTS: 6.5; p=0.009) and second week (LAC: 5.3; SSTS: 6.8; p=0.024). The rest of radiological measurements were comparable. In the LAC group, seven patients had re-intervention (three manipulations, four surgeries) and in the SSTS group, three patients had re-intervention (two manipulations, one surgery) (p=0.657).

Conclusion: Our study results suggest that SSTS and LAC are comparable in terms of radiological results and need for re-intervention as an immobilization method of pediatric distal forearm fractures.

Declarations

Ethics Committee Approval

The study protocol was approved by the Ege University Faculty of Medicine Medical Research Ethics Committee (date: 28.05.2020, no: 20-5.1T/43). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Design, analysis, writing the article: A.E.D.; Idea, design, data collection: A.V.; Idea, data collection, literature review: O.A.; Data collection, literature review: B.K.; Supervision, critical review: L.K.; Design, supervision: E.C.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Alagöz E, Güleç MA. Factors affecting re-displacement in pediatric forearm fractures and the role of cast indices. Jt Dis Relat Surg 2020;31:95-101. DOI: 10.5606/ehc.2020.71523.
  2. Koluaçık S, Yılmaz Ö, Aslantürk O. Treatment of a neglected flexor digitorum profundus entrapment after closed reduction of both bone forearm fracture: A case report. Jt Dis Relat Surg 2021;32:810-3. DOI: 10.52312/jdrs.2021.389.
  3. Caruso G, Caldari E, Sturla FD, Caldaria A, Re DL, Pagetti P, et al. Management of pediatric forearm fractures: What is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg 2021;105:225-34. DOI: 10.1007/s12306-020-00684-6.
  4. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146-56. DOI: 10.5435/00124635-199805000-00002.
  5. Rai P, Haque A, Abraham A. A systematic review of displaced paediatric distal radius fracture management: Plaster cast versus Kirschner wiring. J Clin Orthop Trauma 2020;11:275-80. DOI: 10.1016/j.jcot.2019.03.021.
  6. Ömeroğlu H. Basic principles of fracture treatment in children. Eklem Hastalik Cerrahisi 2018;29:52-7. DOI: 10.5606/ehc.2018.58165.
  7. Murphy RF, Plumblee L, Sleasman B, Barfield W, Dow MA, Mooney JF 3rd. Clinical and radiographic comparison of single-sugar-tong splint to long-arm cast immobilization for pediatric forearm fractures. J Pediatr Orthop B 2019;28:549- 52. DOI: 10.1097/BPB.0000000000000572.
  8. Levy J, Ernat J, Song D, Cook JB, Judd D, Shaha S. Outcomes of long-arm casting versus double-sugar-tong splinting of acute pediatric distal forearm fractures. J Pediatr Orthop 2015;35:11-7. DOI: 10.1097/BPO.0000000000000196.
  9. Dittmer AJ, Molina D 4th, Jacobs CA, Walker J, Muchow RD. Pediatric forearm fractures are effectively immobilized with a sugar-tong splint following closed reduction. J Pediatr Orthop 2019;39:e245-7. DOI: 10.1097/BPO.0000000000001291.
  10. Chaudhury S, Hazlerigg A, Vusirikala A, Nguyen J, Matthews S. Lower limb intracast pressures generated by different types of immobilisation casts. World J Orthop 2017;8:170-7. DOI: 10.5312/wjo.v8.i2.170.
  11. Schulte D, Habernig S, Zuzak T, Staubli G, Altermatt S, Horst M, et al. Forearm fractures in children: Split opinions about splitting the cast. Eur J Pediatr Surg 2014;24:163-7. DOI: 10.1055/s-0033-1341412.
  12. Shuler FD, Grisafi FN. Cast-saw burns: Evaluation of skin, cast, and blade temperatures generated during cast removal. J Bone Joint Surg [Am] 2008;90:2626-30. DOI: 10.2106/JBJS.H.00119.
  13. Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg [Am] 2006;88:9-17. DOI: 10.2106/JBJS.E.00131.
  14. Howell DM, Bechmann S, Underwood PJ. Wrist Splint. StatPearls [Internet]; StatPearls Publ Treasure Island, FL, USA, 2022 Available at: https//www.ncbi.nlm.nih.gov/ books/NBK557630/.
  15. Grafstein E, Stenstrom R, Christenson J, Innes G, MacCormack R, Jackson C, et al. A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures. CJEM 2010;12:192- 200. DOI: 10.1017/s1481803500012239.
  16. Atik OŞ. Which articles do the editors prefer to publish? Jt Dis Relat Surg 2022;33:1-2. DOI: 10.52312/jdrs.2022.57903.
  17. Levy J, Ernat J, Song D, Cook JB, Judd D, Shaha S. Outcomes of long-arm casting versus doublesugar-tong splinting of acute pediatric distal forearm fractures. J Pediatr Orthop 2015;35:11-7. DOI: 10.1097/BPO.0000000000000196.
  18. Murphy RF, Sleasman B, Osborn D, Barfield WR, Dow MA, Mooney JF 3rd. A single sugar-tong splint can maintain pediatric forearm fractures. Orthopedics 2021;44:e178-82. DOI: 10.3928/01477447-20201119-06.
  19. Denes AE Jr, Goding R, Tamborlane J, Schwartz E. Maintenance of reduction of pediatric distal radius fractures with a sugar-tong splint. Am J Orthop (Belle Mead NJ) 2007;36:68-70.
  20. Acree JS, Schlechter J, Buzin S. Cost analysis and performance in distal pediatric forearm fractures: Is a short-arm cast superior to a sugar-tong splint? J Pediatr Orthop B 2017;26:424-8. DOI: 10.1097/BPB.0000000000000382.
  21. Belthur MV, Jones S, Fernandes JA. A novel method of applying a split cast. Injury 2005;36:1135-7. DOI: 10.1016/j.injury.2004.11.005.
  22. Younger AS, Curran P, McQueen MM. Backslabs and plaster casts: Which will best accommodate increasing intracompartmental pressures? Injury 1990;21:179-81. DOI: 10.1016/0020-1383(90)90091-8.
  23. Mohamed-Zain NA, Jamil K, Penafort R, Singh A, Ibrahim S, Abdul-Rashid AH. Anxiety reaction in children during cast removal using oscillating saw versus cast shear - a randomised, prospective trial. Malays Orthop J 2021;15:122- 8. DOI: 10.5704/MOJ.2107.018.