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Letters to the Editor   |    
Comparison of Short and Long Arm Plaster Casts for Displaced Fractures in the Distal Third of the Forearm in Children
Gunasekaran Kumar1
1 Worthing and Southlands Hospital NHS Trust Lyndhurst Road Worthing, West Sussex BN11 2DH United Kingdom gunasekarankumar@hotmail.com
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The author did not receive grants or outside funding in support of his research for or preparation of this work. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1888-1888
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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.
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