Management of Distal 1/3rd Closed Forearm Fractures in Children above Elbow Plaster Cast versus Below Elbow Plaster Cast

Objective: To determine if below-elbow casts are as effective as above-elbow casts in the treatment of the distal third closed forearm fractures in children. Materials and Methods: This was a prospective comparative study and was conducted at orthopaedic department of Liaquat University of Medical and Health Sciences (LUMHS). Children 4 to 12 years of age who presented to, distal 1/3rd fractures of the forearm were randomized in order to manage with either an above-elbow or below-elbow cast after closed reduction under fluoroscopic guidance. Radiographic analysis was done for angulation and displacement at the injury time, following reduction, and at subsequent intervals of follow-up. At the fracture level, the cast index for evaluating the cast moulding quality was assessed from the post-reduction radiographs. Variations between post-reduction and final values for displacement and angulation, the range of motion of elbow, forearm and wrists and cast indices between the two groups were compared. Results: Of total 50 study subjects, 26 underwent above-elbow cast and 24 subjects underwent below-elbow cast techniques. Mean age of above-elbow cast group patients was 9.42 year and the mean age in of below-elbow cast group patients was 9.13 years. 15 male and 11 female patients were present in above-elbow cast group; 14 male and 10 female patients were present in below-elbow cast group. The mean cast index of above-elbow cast group was 0.71 and the mean cast index of below-elbow cast was 0.70. In terms of patient demographics, injury mechanism, characteristics of initial fracture, cast index or shift in displacement and angulation during treatment, no significant variances were observed between both groups. In above-elbow cast group, the mean elbow arc of motion on cast removal at six weeks was only 78° compared to 141.6° in below-elbow cast group. There was a significant decline in arc of motion of elbow joint in above-elbow cast group compared to below-elbow cast group in six weeks which became normal at final follow-up in three months. The complication rates in both the groups were similar. Conclusion: Below-elbow cast is the safe reliable and cost-effective method of cast immobilization in distal third forearm fractures in the children of 4 to 12 years of age.