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Evidence-Based Orthopaedics   |    
A Splint Was Not Inferior to a Cast for Distal Radial Fracture in Children
Charles T. Price, MD
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University of Central Florida College of Medicine, Orlando, Florida

Source of funding: SickKids Foundation.
For correspondence: Dr. K. Boutis, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. E-mail address: boutis@pol.net
For a glossary of terms for evidence-based orthopaedics, go to jbjs.org/ebo_glossary.
Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. The author, or a member of his immediate family, received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet).

Boutis  K,  Willan  A,  Babyn  P,  Goeree  R,  Howard  A. Cast Versus Splint in Children with Minimally Angulated Fractures of the Distal Radius: A Randomized Controlled Trial. CMAJ.2010Oct5;182(14):1507-12.
Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 18;93(10):970-970. doi: 10.2106/JBJS.9310ebo619
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    Rajinder Singh Gaheer, Amanda Hawkins
    Posted on June 01, 2011
    Splintage is sufficient for minimally displaced fractures of distal radius in children
    Dumfries and Galloway Royal Infirmary, United Kingdom

    We read with interest the commentary by Charles T. Price1 on the study by Boutis et al.2 regarding use of splintage for treatment of minimally angulated or minimally displaced greenstick or transverse fracture of the distal radius. In the setting of a district general hospital, we have devised a protocol for treatment of these injuries. This protocol is based on the one described by Davidson et al.3 for treatment of torus fractures of distal radius. In our trust, all fractures seen in the emergency department which are undisplaced or minimally displaced and do not need immediate input from the on-call trauma team are placed in slabs and brought back to the consultant led trauma clinic the next day. The idea behind the practice being that all fracture patients are seen by a consultant within 24 hours of presentation in the emergency department. This certainly minimises the chances of finding surprises in the fracture clinics two to three weeks after the initial injury. All children from 2-12 years, skeletally immature, who present to the emergency department with a minimally angulated or minimally displaced acute greenstick or transverse fracture of the distal part of the radius are reviewed as part of trauma clinic protocol by the on-call consultant in the next trauma clinic (within the next 24 hours). The greenstick fractures are placed in futura splint and the transverse fractures are placed in plaster cast. The ones in futura splints are provided with an instruction leaftlet similar to the one described by Davidson et al.3 The parents are instructed to remove the splint at three weeks and start mobilising the wrist without needing another attendance in the clinic. The ones in plaster cast are seen back in a nurse led fracture clinic three to four weeks after the injury. The plaster is removed at that stage and mobilisation commenced. In both cases the patients are instructed to avoid lifting anything heavy or using their hand for vigorous activity for another couple of weeks after splint or cast removal. This has significantly reduced the follow-up load on the fracture clinics without compromising the quality of care provided for these injuries. The effective utilisation of nurse led fracture clinic has also given us the opportunity to think about extending the spectrum of trauma patients who can be seen in these clinics. This study would encourage us to further extend the indications of removable splints for the minimally displaced and minimally angulated transverse fractures of the distal radius. The workload of the plaster room staff, the number of patients attending the follow-up fracture clinics and the time spent in the department by children and their parents/carers would also be, therefore, reduced. References 1) Price CT. A splint was not inferior to a cast for distal radial fracture in children. J Bone Joint Surg Am. 2011 May;93(10):970. 2) Boutis K, Willan A, Babyn P, Goeree R, Howard A. Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial. CMAJ. 2010 Oct 5;182(14):1507-12. 3) Davidson JS, Brown DJ, Barnes SN, Bruce CE. Simple treatment for torus fractures of the distal radius. J Bone Joint Surg Br. 2001 Nov;83(8):1173-5.

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