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Aims: The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups. Methods: A prospectively registered (ISRCTN95922938) randomized parallel group trial will be conducted. Elderly patients meeting the inclusion criteria with a dorsally displaced distal radius facture will be randomized (1:1 ratio) to either conservative management (cast without further manipulation) or surgery. Patients will be assessed at six, 12, 26 weeks, and 52 weeks post intervention. The primary outcome measure and endpoint will be the Patient-Rated Wrist Evaluation (PRWE) at 52 weeks. In addition, the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH), EuroQol five-dimension questionnaire, pain score (visual analogue scale 1 to 10), complications, grip strength (dynamometer), range of motion (goniometer), and radiological assessments will be undertaken. A cost-utility analysis will be performed to assess the cost-effectiveness of surgery. We aim to recruit 89 subjects per arm (total sample size 178). Discussion: The results of this study will help guide treatment of dorsally displaced distal radial fractures in the elderly and assess whether surgery offers functional benefit to patients. This is an important finding, as the number of elderly distal radial fractures is estimated to increase in the future due to the ageing population. Evidence-based management strategies are therefore required to ensure the best outcome for the patient and to optimize the use of increasingly scarce healthcare resources. Cite this article: Bone Jt Open 2024;5(10):920–928.

Introduction: Distal radius fractures make up around 20% of adult fractures, varying in type and severity, thus requiring different treatments. Cast immobilization is effective in indicated fractures, but is associated with several disadvantages such that 3D-printed orthoses (3D-Braces) have been introduced as a potentially advantageous alternative. The present study was designed to test the hypothesis that short-arm 3D-printed Polylactic Acid (PLA) orthoses would provide superior biomechanical properties when compared to plaster of Paris short-arm casts for immobilization of distal radial fractures. Methods: Modified mannequin forearms were utilized as human models for the creation of both the circular casts and the 3D Braces. A total of five plaster cast prototypes were produced, based on a standard cylindrical plaster cast application technique used in the treatment of distal radius fractures, and another five samples were 3D printed braces. Each sample was then subjected to a three-point bend load test, using an Instron 68SC2 testing machine, and the data was collected and exported to an Excel spreadsheet and analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, N.Y., USA). Results: The 3D-Braces can withstand significantly higher forces at yield and maximum force, implying they may offer superior mechanical stability. Moreover, our findings indicated a higher strain at yield for the 3D-Braces compared to conventional plaster casts. Conclusions: 3D-printed Polylactic Acid short-arm orthoses demonstrated superior biomechanical properties when compared to plaster of Paris short-arm casts designed for immobilization of distal radial fractures. Taken together with data from previous studies, preclinical evidence suggests that PLA 3D-Braces can effectively maintain distal radius fracture alignment and stability with potential advantages over traditional casts with respect to biomechanical properties as well as post-fabrication adjustment, patient hygiene, comfort, and daily activities.

The purpose of the study was to compare the efficacy of 6 different commercially available waterproof cast protectors in their ability to maintain a dry environment and evaluate whether cast protectors perform better than a plastic bag secured with tape in keeping casts dry. We enrolled 23 adult participants to test 6 different commercially available cast protectors and a plastic bag. Participants trialed all cast protectors twice, with and without motion, by fully submerging each cast protector in water with a paper towel held between their index and middle fingers. Moisture accumulation within the cast protectors was estimated by the change in weight of paper towel. An analysis of variance test was performed to compare differences between cast protectors in their ability to maintain a dry internal environment. The plastic bag showed an average moisture accumulation of 5.50 g without motion compared with all other cast protectors, which had 0.0 g of moisture accumulation. One cast protector and the plastic bag had an average moisture accumulation of 0.46 g and 4.51 g with motion compared to all other cast protectors. The plastic bag was ranked the worst by 100% of participants. Cast protectors appear to offer superior protection from moisture compared with a plastic bag. Therapeutic IV. [ABSTRACT FROM AUTHOR]

Abstract Background There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated. Methods/design This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months. Discussion The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery. Trial registration Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311 .

Objectives. Distal radius fractures represent one of the most frequent injuries in children. The treatment of choice is a closed reduction followed by immobilisation in plaster cast; the immediate recourse to osteosynthesis with Kirschner wires is only reserved for certain cases. The displacement rate reported in the literature is 21-39%. The aim of this study is to retrospectively evaluate the risk factors for a secondary displacement of metaphyseal radius fractures in a paediatric population treated in three different centres. Materials and methods. The initial treatment for all 360 patients examined was a closed reduction under general anaesthesia and immobilisation in an above elbow cast for 4 weeks. The pre-operative displacement, residual post-reduction displacement and possible displacement at 7 and 14 days of follow-up were all assessed clinically and radiographically. Results. A loss of reduction was reported in 102 cases; 51 underwent an additional reduction procedure - some followed by osteosynthesis - while in the remaining 51 cases, the loss of reduction was acceptable in relation to the expectation of remodelling. The most statistically significant variable for the occurrence of a secondary displacement is a severe primary displacement. The association with the ulna fracture is not significantly correlated. The quality of the plaster cast is important for maintaining the reduction. There are a few things to consider as indicators for a second procedure: age, time elapsed from moment of fracture, fracture site and the absence of an acceptable reduction. Conclusions. In our experience, a reduction followed by osteosynthesis with Kirschner wires should be considered the treatment of choice in fractures with a high risk of secondary displacement, namely those with severe initial displacement or unsatisfactory reduction. [ABSTRACT FROM AUTHOR]

Introduction: Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8-12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks.Materials and Methods: In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient sex, age, a description of radiographic fracture consolidation, fracture tenderness and duration of cast immobilization completed (8 versus 12 weeks). To assess the impact of clinical factors on recommendation to continue immobilization we calculated posterior probabilities and determined variable importance using a random forest algorithm. Multilevel logistic mixed regression analysis was used to identify surgeon characteristics associated with recommendation for additional cast immobilization.Results: Unclear fracture healing on radiographs, fracture tenderness and 8 (versus 12) weeks of completed cast immobilization were the most important factors influencing surgeons' decision to recommend continued cast immobilization. Women surgeons (OR 2.96; 95% CI 1.28-6.81, p  =  0.011), surgeons not specialized in orthopedic trauma, hand and wrist or shoulder and elbow surgery (categorized as 'other') (OR 2.64; 95% CI 1.31-5.33, p  =  0.007) and surgeons practicing in the United States (OR 6.53, 95% CI 2.18-19.52, p  =  0.01 versus Europe) were more likely to recommend continued immobilization.Conclusion: Adoption of shorter immobilization times for CT-confirmed nondisplaced scaphoid waist fractures may be hindered by surgeon attention to fracture tenderness and radiographic appearance. [ABSTRACT FROM AUTHOR]

There is approximately a 2% risk of clinically significant VTE following temporary lower limb immobilisation after injury with an ankle immobilising plaster cast or boot. There is evidence that thromboprophylaxis for lower limb immobilised patients reduces the risk of VTE by approximately 50% but there is no international consensus as to which patients should receive thromboprophylaxis. The Plymouth VTE Risk Score was developed to identify patients at particular risk of VTE, in order to offer chemical prophylaxis to reduce their VTE risk. The score showed high completion rates, reliability and consistency. Using the Plymouth VTE Risk Score Version 3 (2014), we found an incidence of clinical VTE of 0.36% with 37.6% of patients being advised to have thromboprophylaxis. This is a lower VTE incidence than in most other studies of this patient group, which is of the order of 2 to 3%. The optimal RAM to use in clinical practice is yet to be defined, further clinical research is needed to accurately stratify patient risk and to define optimal risk treatment levels. We suggest research should focus on comparative clinical studies of risk assessment models. [ABSTRACT FROM AUTHOR]

We report on our experience of using a short, moulded metacarpal cast over a 4-year period in the non-surgical management of metacarpal shaft fractures. Between 6 April 2015 and 6 April 2019, 117 patients were treated using this method. The majority were male, and the mean age was 24.6 years. The most common mechanism of injury was a punch injury (73 patients, 62%). Fifteen patients (13%) were treated for multiple metacarpal fractures. Immediately after cast removal, 68% had a full range of finger movement and 68% were pain free. Few required formal hand therapy. Fifteen patients experienced minor complications, primarily soft tissue irritation from the cast and non-limiting extensor lag. The moulded short metacarpal cast is an effective non-surgical treatment for angulated extra-articular metacarpal fractures of the diaphysis and diametaphyseal junction. Level of evidence: IV [ABSTRACT FROM AUTHOR]

The decision to continue immobilization of a nondisplaced scaphoid waist fracture is often based on radiographic appearance (despite evidence that radiographs are unreliable and inaccurate for diagnosing scaphoid union 6–12 weeks after fracture) and fracture tenderness (even though it is influenced by cognitive biases on pain). This may result in unhelpful additional immobilization. We studied nondisplaced scaphoid waist fractures to determine the factors associated with (1) the surgeon's decision to continue cast or splint immobilization at the first visit when cast removal was being considered; (2) greater pain on examination; and (3) the surgeon's concern about radiographic consolidation. We prospectively included 46 patients with a nondisplaced scaphoid waist fracture treated nonoperatively. At the first visit when cast removal was considered – after an average of 6 weeks of immobilization – patients rated pain during 4 examination maneuvers. The treating surgeon assessed union on radiographs and decided whether to continue or discontinue immobilization. Patients completed measures of the following: (1) the degree to which pain limits activities (Patient-Reported Outcome Measure Interactive System [PROMIS] Pain Interference Computer Adaptive Test [CAT], Pain Self-Efficacy Questionnaire-2); (2) symptoms of depression (PROMIS Depression CAT); and (3) upper extremity function (PROMIS Upper Extremity Function CAT). We used multivariable regression analysis to investigate the factors associated with each outcome. Perceived inadequate radiographic healing and greater symptoms of depression were independently associated with continued immobilization. Pain during the examination was not associated with continued immobilization. Patient age was associated with pain on examination. Shorter immobilization duration was the only factor associated with the surgeon's perception of inadequate radiographic consolidation. Inadequate radiographic healing and greater symptoms of depression are associated with a surgeon's decision to continue cast or splint immobilization of a nondisplaced scaphoid waist fracture. Overreliance on radiographs and inadequate accounting for psychological distress may hinder the adoption of shorter immobilization times for nondisplaced waist fractures. [ABSTRACT FROM AUTHOR]

Abstract Background Bone fractures are one of the most common injuries in the USA. Fiberglass tape is a commonly used casting material, and many medical professionals apply adjuvants including liquid hand soap, foam sanitizers, and ultrasound gel in the hopes of improving outcomes relating to ease of molding and eventual strength, lamination, and smoothness of cast material. However, the efficacy of these agents to improve fiberglass cast mechanics has not been scientifically evaluated. The purpose of this study was to assess the mechanical effects of commonly used adjuvants on fiberglass cast materials. Methods Studies compared regularly shaped samples of water-activated, untreated fiberglass tape (Ossur Techform Premium) to water-activated fiberglass tape treated with one of three commonly used adjuvants (liquid soap, foam hand sanitizer, or ultrasound gel) during lamination. Material stiffness, yield stress, and ultimate load were measured by 3-point bending. Results These studies demonstrated that that liquid soap and ultrasound gel did not affect fiberglass tape mechanical properties, but alcohol-based foam sanitizer significantly reduced stiffness (− 32.8%), yield stress (− 33.6%), and ultimate load (− 31.0%) of the cast material as compared to the control group. Regression slopes were not significantly different between groups, suggesting that no adjuvants improved material curing time. Conclusions These data suggest that the application of adjuvants is not beneficial and potentially harmful to fiberglass cast behavior. Despite the widespread practice of adjuvant application by medical professionals during casting, results from the current study suggest that use of these agents for structural enhancement of fiberglass casts is not beneficial and should largely be discouraged.

Background: There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated.Methods/design: This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months.Discussion: The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery.Trial Registration: Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311 . [ABSTRACT FROM AUTHOR]

Background: Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age. Patients and Methods: This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days. Results: Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to 5 min after the procedure. Median VAS score for the maximum remembered pain measured after 30 min was 0. Median differences in angulation between proximal and distal bone fragments before and after the intervention were 0° (p < 0.0001) in the a.p. view and 8.4° (p < 0.0001) in the lateral view. Conclusion: Cast wedging improved the position of forearm fracture fragments at the expense of minimal short-term pain. [ABSTRACT FROM AUTHOR]

To show up in an exercise activity a five-year-old mare was injured in left hind limb when being transferred by horse tow truck. Nevertheless, was carried to the sport club. The natural vital signs were recognized in physical examination. No weighing on injured limb was reported. In radiological evaluation the second and fourth proximal metatarsal fracture had been oblique and closed. No ligament and tendon damages were ever claimed through ultrasonography survey. A day after limb splinting and temporary plaster casting, through general anesthesia the plaster was taken off the damaged limb. For the second time, plastering the damaged limb was fulfilled, after 20 minutes' traction was applied. Plaster removing occurred after 8 weeks and the patient had no full weighing on involved limb with a moderate lameness as well. Thus the horse was recommended to meet physiotherapy with hoof trimming for 8 weeks. Perfect weighing with no lameness was reported after 16 weeks past from fracture occurrence. To fix a limb in splint bone fracture, plaster casting is an easy and more practical method for field condition, in comparison to others. To monitor the process of success, radiological evaluation is needed. [ABSTRACT FROM AUTHOR]

Background: Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age. Patients and Methods: This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days. Results: Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to 5 min after the procedure. Median VAS score for the maximum remembered pain measured after 30 min was 0. Median differences in angulation between proximal and distal bone fragments before and after the intervention were 0° (p < 0.0001) in the a.p. view and 8.4° (p < 0.0001) in the lateral view. Conclusion: Cast wedging improved the position of forearm fracture fragments at the expense of minimal short-term pain.

Background Mini C-arm image intensifiers ( IIs) are promoted to permit lower radiation dose than traditional IIs with a lower purchase price and without the need for a radiographer, saving time. In real-world usage, radiation dose is not always lower. Methods A retrospective review of prospectively collected data for 620 children undergoing forearm fracture reduction in theatre was undertaken. Imaging was performed with the Fluoroscan mini C-arm or a comparison traditional II. Radiation dose and theatre time were recorded. Results There was no significant difference in radiation dose as measured by dose-area product (0.013 versus 0.014 Gy.cm2, P = 0.22). We noted an inverse association between operator experience and radiation dose. The mini C-arm allowed a shorter procedure time (26 versus 30 min, P < 0.001) and theatre time (13 versus 16 min, P < 0.001). Re-displacement rates were similar (1.3 versus 2.2%). The Fluoroscan is AU$120 000 cheaper to purchase and AU$35 283 cheaper to run per year than the comparison II. Consultants had a 14% lower dose-area product (0.012 versus 0.014 Gy.cm2, P < 0.001) and 18% shorter screening time (8 versus 9.8 s, P < 0.001) than registrars. Conclusion The Fluoroscan mini C-arm II does not demonstrate a radiation saving during closed reductions of paediatric forearm fractures but allows shorter procedures and theatre time with similar re-displacement rates. The purchase price is lower than a traditional II. We noted that operator experience reduces radiation dose. [ABSTRACT FROM AUTHOR]

Kırık stabilizasyonunda yaygın olarak kullanılan alçı uygulamalarının komplikasyonu olarak kompartman sendromu oluşabilir. Bu sendrom; dokulardaki basınç artışı, ödem veya hemoraji nedeniyle kompartman alanının azalması yada kompartman içi volüm artışına bağlı olarak gelişir. Bütün bunların sonucunda oluşan arterioler kompresyon ile kas ve sinir iskemisi oluşur. Kişinin hareketlerini kısıtlayan ,özellikle kasın pasif olarak gerilmesi ile artış gösteren şiddetli ve sürekli ağrı yaygındır. Ekstremitede şişlik, ciltte renk değişikliği, solukluk ya da arteriyel pulsasyonun alınamaması gibi dolaşım bozukluğuna ait bulgular, periferik sinir hasarına bağlı olarak sensorimotor defisitler görülebilir. Tanıda klinik bulgular, kompartman içi basınç ölçümü ve elektronöromyografi (ENMG) kullanılabilir. Etyoloji ve ağrı tedavisine ek olarak fasiyotomi, fizik tedavi modaliteleri, tendon transferleri yapılabilmektedir. Bu olgu sunumunda, kırık nedeniyle uygulanan alçı sonrası gelişen kompartman sendromuna bağlı olarak periferik sinir lezyonu saptanan üç hastayı tartışıyoruz.

Compartment syndrome can occur as a result of the complication of the plaster cast applications ,which are frequently used for fracture stabilization. This syndrome occurs due to increased compartment volume or shrinking of compartment area because of edema, hemorrage or high pressure of tissues. All of these mechanisms causes arteriolar compression, resulting nerve and muscle ischemia. Intensive and continuous pain is common and limits the motions of the patient and increases with passive stretching of the involved muscles. Swelling of limb, change in skin color, peripheral vasculatory failure symptoms such as pallor,weak arterial pulsation and as a result of peripheral nerve damage, sensorimotor deficit can also be observed. Clinical evaluation, measure of pressure within the compartment, and electroneuromyography (ENMG) can be used for the diagnosis. In addition to treatment of to the treatment of etiology and pain, further treatment options such as fasciotomy, physiotherapy modalities, tendon transfers, can be performed. In this case report, we will discuss three patients with nerve lesions as a result of the compartment syndrome that developed due to the plaster casting of bone fractures. [Cukurova Med J 2013; 38(4.000): 774-778]

Introduction: The majority of displaced distal radius fractures are managed by closed reduction and cast immobilisation. Redisplacement is associated with initial displacement, imperfect reduction and quality of cast. The aim of this study was to establish which factors predict the risk of redisplacement. Materials and methods: A retrospective analysis between September 2010 and April 2013 of children who underwent closed manipulation and cast immobilisation for a distal third radius fracture was performed. Open fractures, those treated with fixation, and cases with associated dislocations or physeal injuries were excluded. Initial fracture translation and angulation, the distance from the physis and the presence of an ulna fracture were recorded. Intra-operative radiographs were analysed to assess reduction, the cast index and gap index. Clinic records and post-operative radiographs were reviewed to identify redisplacement or further surgical intervention. Results: During the study period, 107 children underwent closed reduction and casting: 82 boys (76.6 %) and 25 girls (23.4 %), and the mean age of the group was 10 years. Twenty-nine children (27 %) suffered a radiographic redisplacement although only five children underwent a second surgical intervention. Statistically significant risk factors for redisplacement were initial fracture translation ( p < 0.001), success of reduction ( p < 0.001) and associated ulna fracture ( p = 0.021). Both the mean cast index (0.81 vs. 0.78) and mean gap index (0.16 vs. 0.14) were higher in the redisplaced group, but this did not reach statistical significance. Conclusion: Closed reduction and immobilisation of paediatric distal radius fractures is associated with a high redisplacement rate. Initial fracture type and success of reduction are key risk factors. [ABSTRACT FROM AUTHOR]

The average time for healing after mid and lower femoral shaft fracture in adult men requires about 8 weeks in traction. We have successfully adapted a technique of cast bracing within the resources of many district hospitals which substantially shortens the in-hospital admission time to about 4 weeks. [ABSTRACT FROM AUTHOR]

Background: Localized hypertrichosis following cast application has been recorded, yet no studies characterized these changes systematically. Objective: To evaluate changes of hair length, diameter and density on the legs in patients after cast application. Materials and methods: Patients with leg injuries and cast application of at least 4 weeks' duration were included in the study. Immediately after cast removal, hair sampling was taken from both legs; cast and control sides. Hair length and diameter were measured by Olympus microscope software. Patients were also analyzed for global changes by three blinded dermatologists. Results: Fourteen patients, seven of whom were male, were included in this study. On the cast side, both hair length and diameter were significantly greater than the control side ( p < 0.001). Subjective evaluations by three blinded dermatologists agreed well with objective measurements and also demonstrated an increase in overall density. Degrees of hair changes did not correlate with the distance from injury sites. Conclusion: Cast application of at least 4 weeks' duration significantly stimulates hair growth in a diffuse pattern. This could possibly lead to novel therapeutic approaches for different types of alopecias. [ABSTRACT FROM AUTHOR]

Background: Ankle fractures account for 9% of all fractures with a quarter of these occurring in adults over 60 years. The short term disability and long-term consequences of this injury can be considerable. Current opinion favours open reduction and internal fixation (ORIF) over non-operative treatment (fracture manipulation and the application of a standard moulded cast) for older people. Both techniques are associated with complications but the limited published research indicates higher complication rates of fracture malunion (poor position at healing) with casting. The aim of this study is to compare ORIF with a modification of existing casting techniques, Close Contact Casting (CCC). We propose that CCC may offer an equivalent functional outcome to ORIF and avoid the risks associated with surgery. Methods/Design: This study is a pragmatic multi-centre equivalence randomised controlled trial. 620 participants will be randomised to receive ORIF or CCC after sustaining an isolated displaced unstable ankle fracture. Participants will be recruited from a minimum of 20 National Health Service (NHS) acute hospitals throughout England and Wales. Participants will be aged over 60 years and be ambulatory prior to injury. Follow-up will be at six weeks and six months after randomisation. The primary outcome is the Olerud & Molander Ankle Score, a functional patient reported outcome measure, at 6 months. Follow-up will also include assessments of mobility, ankle range of movement, health related quality of life and complications. The six-month follow-up will be conducted face-to-face by an assessor blinded to the allocated intervention. A parallel economic evaluation will consider both a health service and a broader societal perspective including the individual and their family. In order to explore patient experience of their treatment and recovery, a purposive sample of 40 patients will also be interviewed using a semi-structured interview schedule between 6-10 weeks post treatment. [ABSTRACT FROM AUTHOR]

Compartment syndrome can occur as a result of the complication of the plaster cast applications ,which are frequently used for fracture stabilization. This syndrome occurs due to increased compartment volume or shrinking of compartment area because of edema, hemorrage or high pressure of tissues. All of these mechanisms causes arteriolar compression, resulting nerve and muscle ischemia. Intensive and continuous pain is common and limits the motions of the patient and increases with passive stretching of the involved muscles. Swelling of limb, change in skin color, peripheral vasculatory failure symptoms such as pallor,weak arterial pulsation and as a result of peripheral nerve damage, sensorimotor deficit can also be observed.Clinical evaluation, measure of pressure within the compartment, and electroneuromyography (ENMG) can be used for the diagnosis. In addition to treatment of to the treatment of etiology and pain, further treatment options such as fasciotomy, physiotherapy modalities, tendon transfers, can be performed. In this case report, we will discuss three patients with nerve lesions as a result of the compartment syndrome that developed due to the plaster casting of bone fractures. [ABSTRACT FROM AUTHOR]

Introduction: 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 randomized 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. Patients and 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 randomized to four weeks BEC (n = 35) or four weeks AEC (n = 31). Primary outcome was limitation of pronation and supination six 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 34 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 six 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) versus 8.4 (±1.4)] and needed significantly less help with dressing (8.2 days versus 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. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: 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. Patients and 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. [Copyright &y& Elsevier]

Introduction: Fractures of the distal third forearm are common fractures in childhood. Most of these fractures can be treated non-operatively by means of closed reduction and immobilization. The purpose of this meta-analysis is to investigate whether above- or below-elbow cast should be considered the first-choice for conservative treatment. Materials and methods: A search was performed in multiple databases to identify all the studies comparing above- and below-elbow cast for the treatment of distal third forearm fractures in children. All RCT's or CCT's were assessed for eligibility. Quality was assessed by the Cochrane Musculoskeletal Injuries Group assessment. Data were pooled using RevMan 5.0 Results: Three trials involving a total of 300 participants were included. A total of 142 fractures were treated with a below-elbow cast (BEC) versus 158 with an above-elbow cast (AEC). Loss of reduction was encountered in 17 and 36 cases, respectively [odds ratio 0.44 (0.22-0.87)]. For combined radius and ulna fractures 15 of 97 in the BEC group and 34 out of 122 in the AEC group showed loss of reduction [odds ratio 0.55 (0.26-1.15)]. Children treated with BEC missed less school days [mean difference 1.12 (−1.52 to −0.59)], and encountered less difficulties in daily living [odds ratio 112.41 (6.58-1920.77)]. Conclusion: Due to heterogeneity, the trials are not fully compared. Based on the presented meta-analysis, we conclude that BEC is not inferior to AEC so that this is a valid treatment option for distal third forearm fractures. [ABSTRACT FROM AUTHOR]

Abstract: Fractures of the distal radius are common. They represent a broad range of injuries, from insufficiency fractures in osteoporosis to high-energy multifragmentary fractures in young adults. The restoration of specific radiological anatomical parameters is associated with a better outcome and a reduced risk of developing degenerative joint disease. Treatment method depends on fracture stability; stable fractures may be amenable to manipulation and casting. Unstable fractures or fractures with depressed articular fragments require surgery. Techniques include casting, manipulation and casting, K-wire fixation, external fixation, open reduction and fixation using plates (icluding volar locking plates). Paediatric fractures may be greenstick or displaced physeal injuries which often require manipulation under anaesthesia before casting. The complications of distal radius fractures include acute carpal tunnel syndrome. [Copyright &y& Elsevier]

Abstract: Forearm injuries are common and require careful management. Treatment methods differ between children and adults. Less severe forces are involved in paediatric fractures, and some degree of angulation is acceptable. Paediatric fractures tend to be treated by closed methods and casting, but flexible intramedullary nails may be required to avoid injury to the physis. Adult fractures require exact anatomical restoration using open reduction, and fixation using compression plates. Complications include forearm compartment syndrome. [Copyright &y& Elsevier]

The use of cast wedging is decreasing. Previous described methods are complicated, using geometric calculations that can be confusing and difficult to remember. We describe a very simple method we use routinely that involves a pen, a piece of paper and a pair of scissors only, without the need to calculate or measure angles. [Copyright &y& Elsevier]