Short vs Long Arm Casts for Broken Arms

Overseen By Emily R Dodwell, MD MPH FRCSC

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Hospital for Special Surgery, New York

Disqualifiers: Open fracture, Pathologic fracture, Refracture, Compartment syndrome, Neuropathy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 6 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether short arm fiberglass casts are as effective as long arm casts for children with broken forearms. Researchers aim to determine if shorter casts can support the healing process after a specific type of fracture has been realigned without surgery, a process known as closed reduction. They also examine how these treatments affect comfort, pain, and any complications. Children aged 4 to 12 with a specific type of displaced forearm fracture that requires realignment, but not surgery, may be suitable for this study. As an unphased trial, this study offers an opportunity to contribute to important research that could improve treatment options for children with similar injuries.

Do I need to stop my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications. It's best to consult with the trial coordinators or your doctor for guidance.

What prior data suggests that these casting methods are safe for treating pediatric forearm fractures?

Research has shown that both short arm and long arm fiberglass casts are safe and effective for treating broken forearms in children. In a study involving 120 children aged 4 to 16, short-arm casts stabilized fractures as effectively as long-arm casts. Both types of casts were well-tolerated, with no major safety issues reported.

Another study found no significant differences in the need for surgery or the healing of arms between the two types of casts, suggesting similar risks for both treatments. While complications like skin irritation or stiffness can occur, they are uncommon and usually mild.

Overall, both short arm and long arm fiberglass casts provide safe options for treating arm fractures in children. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial comparing short arm and long arm fiberglass casts for broken arms because it could redefine how we manage arm fractures. While the standard treatment often involves long arm casts that stabilize the arm from wrist to shoulder, a short arm cast only covers the area from the wrist to just below the elbow. This approach might offer more comfort and easier mobility for patients. If the short arm cast proves to be as effective as the long arm version, it could lead to faster rehabilitation and greater convenience for patients without compromising healing.

What evidence suggests that this trial's treatments could be effective for broken arms?

This trial will compare short arm fiberglass casts with long arm fiberglass casts for stabilizing broken arms in children. Research has shown that short arm fiberglass casts maintain fracture stability as effectively as long arm casts. In one study, 120 children aged 4 to 16 received either short or long arm casts, and both types kept the fracture stable. The short arm cast prevented the bones from moving out of place just as effectively as the long arm cast. Additionally, fiberglass, the material used for both casts, is less likely to cause skin problems compared to other materials. Both types of casts effectively hold the bone in place during healing. ^{1 2 3 6 7}

Who Is on the Research Team?

Emiyl R Dodwell, MD MPH FRCSC

Principal Investigator

Hospital for Special Surgery, New York

Are You a Good Fit for This Trial?

This trial is for children aged 4-12 with a specific type of broken wrist bone that's out of place and needs to be set without surgery. Kids 4-9 must have bones angled over 30 degrees or shifted completely, while those 10-12 need an angle over 15 degrees or more than half shifted. It's not for kids getting other bone procedures, with open fractures, re-broken bones, nerve damage issues, or known weak bones.

Inclusion Criteria

My child's bone is bent more than 15 degrees or shifted over half its width.

My child's bone is bent more than 30 degrees or completely shifted out of place.

I am between 4 and 12 years old.

Exclusion Criteria

I have a fracture due to a disease.

I have compartment syndrome or neuropathy.

I am having other bone surgeries besides fixing a broken arm bone.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either a short arm or long arm fiberglass cast for immobilizing displaced pediatric distal third forearm fractures

6 weeks

1 visit (in-person) for cast application

Follow-up

Participants are monitored for safety, effectiveness, and complications after treatment

6 months

Visits at 1 week, 3 weeks, 6 weeks, 3 months, and 6 months

What Are the Treatments Tested in This Trial?

Interventions

• Closed Reduction
• Long Arm Fiberglass Cast
• Short Arm Fiberglass Cast

Trial Overview The study compares two types of casts for treating displaced wrist fractures in kids: short arm vs long arm fiberglass casts after setting the bone without surgery. The goal is to see if the shorter cast works as well as the longer one by looking at whether the break stays in place and how it affects pain, function, and activity.

How Is the Trial Designed?

Group I: Short Arm Fiberglass Cast Experimental Treatment 2 Interventions

Conscious sedation will be provided to patient while the reduction is performed by a cast trained orthopedic resident using standard techniques under fluoroscopic guidance. The arm will be held by an assistant or finger traps in the absence thereof. The arm will not be suspended until after the manipulation is performed. A stockingette and webril will first be applied, after which the short arm fiberglass portion of the cast will be applied. After short arm casting has been appropriately placed, randomization group will be revealed. Casting will be complete at this point if the patient is assigned to the short arm cast group. The mold will then be applied and cast construct will be bivalved and taped.

Group II: Long Arm Fiberglass Cast Active Control 2 Interventions

Conscious sedation will be provided to patient while the reduction is performed by a cast trained orthopedic resident using standard techniques under fluoroscopic guidance. The arm will be held by an assistant or finger traps in the absence thereof. The arm will not be suspended until after the manipulation is performed. A stockingette and webril will first be applied, after which the short arm fiberglass portion of the cast will be applied. After short arm casting has been appropriately placed, randomization group will be revealed. Casting will be extended to the shoulder joint if the patient is assigned to the long arm cast group. The mold will then be applied and cast construct will be bivalved and taped.

Who Is Running the Clinical Trial?

Hospital for Special Surgery, New York

Lead Sponsor

Trials

257

Recruited

61,800+

Published Research Related to This Trial

A study involving 120 children aged 4 to 16 years found that short-arm fiberglass casts (SAC) provide fracture stabilization comparable to long-arm casts (LAC) for treating displaced distal forearm fractures after closed reduction.

SAC not only matched the effectiveness of LAC in terms of fracture stability but also allowed for quicker recovery of normal elbow motion and reduced the need for assistance during daily activities, such as showering.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial. Seiler, M., Heinz, P., Callegari, A., et al.[2021]

A well-molded short arm cast is as effective as a long arm cast for treating displaced distal forearm fractures in children aged four and older, based on a study of 113 patients with an average follow-up of eight months.

Patients with short arm casts experienced fewer disruptions to their daily activities and missed fewer school days compared to those with long arm casts, indicating a better quality of life during recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. Webb, GR., Galpin, RD., Armstrong, DG.[2022]

The new short arm cast material can be applied in the same amount of time as conventional fiberglass tape, making it efficient for use in clinical settings.

This new cast allows for better digital motion at the metacarpophalangeal joints while maintaining similar pressure levels beneath the cast, suggesting it may enhance comfort and mobility for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variability of short arm cast application: the influence of experience using fibreglass tape and QuickCast. Cohen, MS.[2019]

Wrapping fiberglass casts with a wet bandage significantly improves their strength and mechanical properties, as shown by increased maximum load, elastic strength, and Young's modulus at full curing time.

Using foam soap during the molding of fiberglass casts did not lead to any significant improvements in cast strength by the time they were fully cured, indicating that this technique may not be beneficial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Different Application Techniques on Fiberglass Casts: A Mechanical Experimental Study. Yalçınozan, M., Sarı, E.[2022]

Distal forearm fractures are the most common childhood fractures, and children often experience significant pain after being discharged from the Emergency Department.

This study aims to compare the pain levels in children treated with short casts versus long casts after a distal forearm fracture reduction, hypothesizing that long casts will result in less pain in the first 48 hours post-discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short and long arm cast and pain after discharge in children who underwent reduction of distal forearm fracture in the Emergency Department: A study protocol for a randomized comparative effectiveness study. Giacalone, M., Capua, T., Shavit, I.[2020]

In a study of 60 children aged 3 to 13 with forearm fractures, no cases of compartment syndrome or neurovascular injury were reported, indicating a high safety profile for the cast types used.

The type of cast (no valve, univalve, or bivalve) did not significantly affect complications, pain levels, or the need for further surgical intervention, suggesting that minimizing cast splitting could improve practice efficiency without compromising patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures. Baldwin, PC., Han, E., Parrino, A., et al.[2018]

A study involving 118 children with upper arm fractures showed that immediate closed reduction and cast immobilization in the emergency room is highly effective, with a 97.6% satisfaction rate from orthopedic evaluations.

Patients, parents, and nursing staff reported an average satisfaction score of 9 out of 10, indicating that this approach is not only safe and effective but also well-received by those involved.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department. Delgove, A., Harper, L., Berciaud, S., et al.[2020]

The study found that different cast-cutting methods significantly reduced skin surface pressure under fiberglass short arm casts, with the triple-cut method eliminating all clinically relevant pressure, while the single-cut and double-cut methods also provided substantial reductions.

Applying an Ace wrap after cutting the cast increased skin surface pressure, which could compromise the effectiveness of the cast-cutting methods, highlighting the need for caution when using Ace wraps post-cast cutting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of bivalving, cast spreading, and webril cutting to reduce cast pressure in a fiberglass short arm cast. Zaino, CJ., Patel, MR., Arief, MS., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10908428/

Evolution in Casting Techniques: A Narrative Review of ... Furthermore, a study used in pediatric distal radius fractures found that a hybrid mesh cast was associated with faster recovery of physical ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT03835065

Long Arm Vs Short Arm Fiberglass Cast for Treatment of ... The aim of the study is to determine by multicenter randomized controlled trial whether short arm fiberglass casts are as effective as long arm casts.

3. withpower.com withpower.com/trial/phase-fractures-bone-1-2019-761e3

Short vs Long Arm Casts for Broken Arms A study involving 120 children aged 4 to 16 years found that short-arm fiberglass casts (SAC) provide fracture stabilization comparable to long-arm casts (LAC) ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/32940750/

Short and long-arm fiberglass cast immobilization for ... The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S2405844023008472

Revolution in orthopedic immobilization materials Generally, fiberglass is a porous material hence it reduces the risk of skin related issues making it suitable for long term immobilization [3].

6. researchgate.net researchgate.net/publication/262023476_Outcomes_of_Long-arm_Casting_Versus_Double-Sugar-Tong_Splinting_of_Acute_Pediatric_Distal_Forearm_Fractures

(PDF) Outcomes of Long-arm Casting Versus Double– ... ... [11,12] Recent studies have reported that STS are as successful as traditional circular casting in the treatment of these fractures. [7, 8 ...

7. omicsdi.org omicsdi.org/dataset/biostudies-literature/S-EPMC7892746

Short and long-arm fiberglass cast immobilization ... The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm ...