Article

Interventions for treating wrist fractures in children

Leicester Royal Infirmary, Department of Paediatric Orthopaedics, Wd 14, Infirmary Square, Leicester, UK, LE1 5WW.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2008; DOI: 10.1002/14651858.CD004576.pub2
Source: PubMed

ABSTRACT Approximately a third of all fractures in children occur at the wrist, usually from falling onto an outstretched hand.
We aimed to evaluate removable splintage versus plaster casts (requiring removal by a specialist) for undisplaced compression (buckle) fractures; cast length and position; and the role of surgical fixation for displaced wrist fractures in children.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 4), MEDLINE (from 1966), EMBASE (from 1988), CINAHL (from 1982) and reference lists of articles. Date of last search October 2007.
Any randomised or quasi-randomised controlled trials comparing types and position of casts and the use of surgical fixation for distal radius fractures in children.
Two authors performed trial selection. All three authors independently assessed methodological quality and extracted data.
The 10 included trials, involving 827 children, were of variable quality.Four trials compared removable splintage versus the traditional below-elbow cast in children with buckle fractures. There was no short-term deformity recorded in all four trials and, in one trial, no refracture at six months. The Futura splint was cheaper to use; a removable plaster splint was less restrictive to wear enabling more children to bathe and participate in other activities, and the option preferred by children and parents; the soft bandage was more comfortable, convenient and less painful to wear; home-removable plaster casts removed by parents did not result in significant differences in outcome but were strongly favoured by parents. Two trials found below-elbow versus above-elbow casts did not increase redisplacement of reduced fractures or cast-related complications, were less restrictive during use and avoided elbow stiffness. One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity. Three trials found that percutaneous wiring significantly reduced redisplacement and remanipulation but one of these found no advantage in function at three months.
Limited evidence supports the use of removable splintage for buckle fractures and challenges the traditional use of above-elbow casts after reduction of displaced fractures. Although percutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including function are not established. Further research is warranted on the optimum approach, including splintage, for buckle fractures; and on the use of below-elbow casts and indications for surgery for displaced wrist fractures in children.

1 Follower
 · 
209 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Abraham A, Handoll HH, Khan T. Interventions for treating wrist fractures in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art No.: CD004576. DOI: 10.1002/14651858.CD004576.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
    Evidence-Based Child Health A Cochrane Review Journal 03/2009; 4(1):382 - 383. DOI:10.1002/ebch.301
  • Source
    Emergency Medicine Journal 11/2009; 26(11):819-22. DOI:10.1136/emj.2009.082891 · 1.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The unlikely event of long-term complications in some pediatric fractures, such as midclavicular fractures, has allowed for management of these injuries with interventions that support the injured extremity rather than immobilize it while healing occurs. However, there is currently a growing body of evidence that advocates for this approach for some of the most frequently encountered pediatric fractures also at very low risk of future problems but, in contrast, have conventionally been managed with orthopedic consultation and rigid casting for several weeks. Therefore, this article will review the evidence that recommends that management of some of the most common upper and lower pediatric extremity fractures be treated with minimal interventions, such as removable splints and follow-up with a primary care provider.
    Pediatric emergency care 02/2010; 26(2):152-7; quiz 158-62. DOI:10.1097/PEC.0b013e3181ce310c · 0.92 Impact Factor

Preview

Download
5 Downloads