Department of Orthopaedic Surgery , Erasmus Medical Center , Rotterdam.
Acta Orthop. 2013 Oct;84(5):489-94. doi: 10.3109/17453674.2013.850010. Epub 2013 Oct 31.
It is unclear whether it is safe to convert above-elbow cast (AEC) to below-elbow cast (BEC) in a child who has sustained a displaced diaphyseal both-bone forearm fracture that is stable after reduction. In this multicenter study, we wanted to answer the question: does early conversion to BEC cause similar forearm rotation to that after treatment with AEC alone?
Children were randomly allocated to 6 weeks of AEC, or 3 weeks of AEC followed by 3 weeks of BEC. The primary outcome was limitation of pronation/supination after 6 months. The secondary outcomes were re-displacement of the fracture, limitation of flexion/extension of the wrist and elbow, complication rate, cast comfort, complaints in daily life, and cosmetics of the fractured arm.
62 children were treated with 6 weeks of AEC, and 65 children were treated with 3 weeks of AEC plus 3 weeks of BEC. The follow-up rate was 60/62 and 64/65, respectively with a mean time of 6.9 (4.7-13) months. The limitation of pronation/supination was similar in both groups (18 degrees for the AEC group and 11 degrees for the AEC/BEC group). The secondary outcomes were similar in both groups, with the exception of cast comfort, which was in favor of the AEC/BEC group.
Early conversion to BEC cast is safe and results in greater cast comfort.
对于已经复位且稳定的儿童移位骨干双骨折，将肘上石膏转换为肘下石膏是否安全尚不清楚。在这项多中心研究中，我们想回答这个问题：早期转换为 BEC 是否会导致与单独使用 AEC 治疗后相似的前臂旋转？
儿童被随机分配接受 6 周的 AEC 治疗，或 3 周的 AEC 治疗后再接受 3 周的 BEC 治疗。主要结局是 6 个月后旋前/旋后受限。次要结局包括骨折再移位、腕关节和肘关节屈伸受限、并发症发生率、石膏舒适度、日常生活中的抱怨以及骨折手臂的外观。
62 名儿童接受了 6 周的 AEC 治疗，65 名儿童接受了 3 周的 AEC 加 3 周的 BEC 治疗。随访率分别为 60/62 和 64/65，平均时间分别为 6.9（4.7-13）个月。两组的旋前/旋后受限相似（AEC 组为 18 度，AEC/BEC 组为 11 度）。两组的次要结局相似，除了石膏舒适度，AEC/BEC 组更优。
早期转换为 BEC 石膏是安全的，并且可以提高石膏的舒适度。
