Letters to the Editor   |    
Gavin R. Webb, MD1
1 Seacoast Orthopedics and Sports Medicine Marsh Brook Professional Center 237 Route 108 Somersworth, NH 03878-1517 GavinWebb@md.aaos.org
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The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1888-a-1889
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G.R. Webb replies:I would like to thank Dr. Kumar for his interest in our study and for raising several important questions. The first issue raised is the explanation for the higher failure rate in the long-arm cast group. As stated in the paper, this result was unexpected. Dr. Kumar suggests that this may be related to the fact that a larger number of the fractures treated in long arm casts involved both the radius and ulna. As seen in Figure 3, there was no significant difference in the distribution of fracture types when they were looked at individually. However, it does appear that when grouped by fractures of the radius only compared with fractures of both bones, there is an uneven distribution (twenty-six short arm and thirty-eight long arm casts). When all fractures involving both bones are considered, these accounted for twenty-six (49%) of the fifty-three short arm casts and thirty-eight (63%) of the sixty long arm casts. Of the twenty-six fractures of both bones treated in short arm casts, only one (4%) failed. Of the thirty-eight treated in long arm casts, seven (18%) failed. If the uneven distribution were the only explanation for the greater number of failures seen in the long-arm cast group, the total number of failures would be larger, but the rate of failure should be similar between the cast groups. Examining all eleven failures, eight involved fractures of both bones, whereas six were complete fractures. It does appear that instability may be more closely related to the involvement of both bones than to the amount of initial displacement.
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