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

Trial Summary

What is the purpose of this trial?

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 for immobilizing displaced pediatric distal third forearm fractures that have undergone closed reduction. The primary outcome is loss of reduction requiring cast wedging, recasting, repeat reduction, or surgical intervention. Secondary outcomes will include Patient Reported Outcome Measures for physical function, such as Pedi-FABS, PROMIS (Patient Reported Outcomes Measurement Information System) Upper Extremities , and UCLA (University of California Los Angelos) Activity Scale, and pain/comfort levels,such as PROMIS Pediatric Pain Interference, PROMIS Pediatric Pain Intensity, and VAS ( Visual Analogue Scale) comfort in cast. In addition, secondary outcomes include complications (skin irritation, compartment syndrome, elbow stiffness, cast saw burns etc). The investigators will assess potential risk factors for loss of reduction including initial displacement, level of fracture (physeal, metaphyseal, meta-diaphyseal), initial translation, initial angulation, age, sex, cast index, padding index, adequacy of initial reduction, and provider level of training.

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 data supports the idea that Short vs Long Arm Casts for Broken Arms is an effective treatment?

The available research shows that both short and long arm casts are effective for treating broken arms in children. One study compared short-arm fiberglass casts to long-arm casts for displaced forearm fractures and found that short-arm casts provide similar stabilization. Another study confirmed that short arm casts are as effective as long arm casts for treating fractures in the distal third of the forearm. This suggests that both types of casts can be effective treatments for broken arms. ^{1 2 3 4 5}

What safety data exists for short and long arm casts for broken arms?

Several studies provide safety data for short and long arm casts in treating broken arms. A randomized controlled trial found that short-arm fiberglass casts offer comparable fracture stabilization to long-arm casts for displaced distal forearm fractures in children. Another study on casting options for pediatric forearm fractures reported no incidents of compartment syndrome or neurovascular injury, and no significant differences in complications between different cast types. Additionally, immediate closed reduction and cast immobilization under sedation in the emergency room is considered safe and effective for upper limb fractures in children. Methods like bivalving and cast spreading can reduce pressure in fiberglass short arm casts, minimizing soft-tissue injury risk. Overall, these studies suggest that both short and long arm casts are safe options for immobilizing broken arms, with no significant safety concerns reported. ^{1 4 5 6 7}

Is the treatment Short Arm Fiberglass Cast a promising treatment for broken arms?

Yes, the Short Arm Fiberglass Cast is a promising treatment for broken arms in children. Studies show it stabilizes fractures as well as long arm casts, is commonly used, and allows for more movement, making it a good option for treating broken arms. ^{1 3 4 7 8}

Research Team

Emiyl R Dodwell, MD MPH FRCSC

Principal Investigator

Hospital for Special Surgery, New York

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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 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]

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]

References

1. Germany pubmed.ncbi.nlm.nih.gov

Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial. [2021]

2. Switzerland pubmed.ncbi.nlm.nih.gov

The Impact of Different Application Techniques on Fiberglass Casts: A Mechanical Experimental Study. [2022]

3. United States 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. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

The effectiveness of bivalving, cast spreading, and webril cutting to reduce cast pressure in a fiberglass short arm cast. [2022]

6. France pubmed.ncbi.nlm.nih.gov

Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department. [2020]

7. Netherlands pubmed.ncbi.nlm.nih.gov

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

8. Netherlands 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. [2020]