http://www.bjj.boneandjoint.org.uk/content/95-B/12/1714.abstract

The treatment of stable paediatric forearm fractures using a cast that may be removed at home

Comparison with traditional management in a randomised controlled trial

1. L. Hutchings, MB BChir in Clinical Medicine, MRCS, Clinical Research Fellow1;
2. E. Tutton, PhD, MSc, RN, Senior Research Fellow1;
3. E. Hodson, MA, BM BChir, FRCA, Wellcome Trust Clinical Research Fellow2;
4. C. H. Smith, MBChB, BSc, MRCGP, Portfolio GP1;
5. J. Wakefield, FRCR, BMBS, BMedSci, Radiologist3;
6. B. Gray, RN, BA Palliative Care, Research Nurse1;
7. S. Symonds, RN, Research Nurse1; and
8. K. Willett, FRCS, Professor of Orthopaedic Trauma Surgery, National Director for Acute Episodes of Care, NHS England1

+ Author Affiliations

1. ¹Kadoorie Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
2. ²Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford, UK.
3. ³The Royal Marsden Hospital NHS Trust, Department of Radiology, Downs Road, Sutton, Surrey SM2 5PT, UK.

1. Correspondence should be sent to Mr T. W. Hamilton; e-mail:thomas.hamilton@ndorms.ox.ac.uk

Abstract

We investigated whether, in the management of stable paediatric fractures of the forearm, flexible casts that can be removed at home are as clinically effective, cost-effective and acceptable to both patient and parent as management using a cast conventionally removed in hospital. A single-centre randomised controlled trial was performed on 317 children with a mean age of 9.3 years (2 to 16). No significant differences were seen in the change in Childhood Health Assessment Questionnaire index score (p = 0.10) or EuroQol 5-Dimensions domain scores between the two groups one week after removal of the cast or the absolute scores at six months. There was a significantly lower overall median treatment cost in the group whose casts were removed at home (£150.88 (sem 1.90) vs £251.62 (sem 2.68); p < 0.001). No difference was seen in satisfaction between the two groups (p = 0.48).

Cite this article: Bone Joint J 2013;95-B:1714–20.

Footnotes

• No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by J. Scott and first-proof edited by D. Rowley.

• Received November 16, 2012.
• Accepted August 27, 2013.

• ©2013 The British Editorial Society of Bone & Joint Surgery