Extract
To The Editor:I read with interest "Comparison of Short and Long Arm Plaster Casts
for Displaced Fractures in the Distal Third of the Forearm in Children"
(2006;88:9-17), by Webb et al. I
congratulate the authors on performing a prospective randomized trial, but I
would ask them to respond to a number of remaining and important
questions.One of the results described in this paper is that long arm casts have a
higher failure rate than short arm casts. A possible reason provided by the
authors is that long arm casts "are technically more difficult to apply,
which results in poorer molding around the forearm." However, the
authors' method of applying a long arm cast was to place a molded short arm
cast first and then convert it into a long arm cast. An extension of a short
arm cast to a long arm cast should not be technically more difficult than
applying a short arm cast alone. A more likely explanation for the
disproportionate failure of long arm casts is that a greater number of the
`unstable' fractures of the distal aspect of the radial shaft were treated
with a long arm cast. According to Figure 3, of the fractures involving both
the radius and the ulna (with partially and completely displaced fractures
combined as a group), only eleven were managed with a short arm cast compared
with twenty that had a long arm cast. Thus, the numbers were not evenly
distributed between the two cast groups.