DiPaola Matthew J, Abzug Joshua M, Pizzutillo Peter D, Herman Martin J
*Department of Orthopaedic, Wright State University School of Medicine, Dayton, OH †Department of Orthopaedic, University of Maryland School of Medicine, Baltimore, MD ‡St. Christopher's Hospital for Children, Philadelphia, PA.
J Pediatr Orthop. 2014 Sep;34(6):643-6. doi: 10.1097/BPO.0000000000000191.
The majority of pediatric fractures are treated in casts due to the child's ability to heal rapidly and remodel. Unplanned cast changes are a time and economic burden with potentially adverse effects on fracture management. The purpose of this study is to document the incidence, etiology, and complications related to unplanned cast changes.
A prospective study was conducted over a 6-month period to determine the incidence of unplanned cast changes. All casts applied were nonwaterproof. Data collected include the reason for cast placement, type of cast placed, duration of wear before the unplanned change, reason for the unplanned change, experience level of the original cast applicator, and cast-related complications.
A total of 1135 casts were placed with 58% placed by a resident, 38% by a cast technician, 2% by a physician's assistant, and 2% by an attending physician. Sixty casts (5.3%) required an unplanned change including 19 short-arm casts, 18 short-leg casts, 17 long-arm casts, 4 thumb spica casts, and 2 long-leg casts. The average duration from cast application until the unplanned change was 13 days. Twenty-eight (47%) were changed for wetness, 20 (33%) for wear/breakage, 2 (3%) for skin irritation, and 10 (17%) for other reasons including objects in the cast and patient self-removal. Two patients had superficial skin infections requiring oral antibiotics. No fracture reductions were lost secondary to an unplanned cast change. The need for an unplanned cast change did not correlate with the level of experience of the applicator.
Most unplanned cast changes were the result of patient nonadherence to instructions and not related to cast application technique. Improved patient and family education regarding cast care may reduce the frequency of unplanned cast changes, thus reducing an economic and time burden on the health care system.
Level II--prognostic study.
由于儿童愈合迅速且具有重塑能力，大多数儿科骨折采用石膏固定治疗。计划外的石膏更换既耗费时间又增加经济负担，对骨折治疗可能产生不利影响。本研究的目的是记录计划外石膏更换的发生率、病因及并发症。
进行了一项为期6个月的前瞻性研究，以确定计划外石膏更换的发生率。所有应用的石膏均为非防水型。收集的数据包括石膏固定的原因、所使用石膏的类型、计划外更换前的佩戴时长、计划外更换的原因、最初石膏固定操作者的经验水平以及与石膏相关的并发症。
共放置了1135个石膏，其中58%由住院医师放置，38%由石膏技师放置，2%由医师助理放置，2%由主治医师放置。60个石膏（5.3%）需要进行计划外更换，包括19个短臂石膏、18个短腿石膏、17个长臂石膏、4个拇指人字形石膏和2个长腿石膏。从石膏固定到计划外更换的平均时长为13天。28个（47%）因潮湿而更换，20个（33%）因磨损/破损而更换，2个（3%）因皮肤刺激而更换，10个（17%）因其他原因更换，包括石膏内有异物和患者自行拆除。两名患者发生浅表皮肤感染，需要口服抗生素治疗。没有因计划外石膏更换而导致骨折复位丢失的情况。计划外石膏更换的需求与操作者的经验水平无关。
大多数计划外石膏更换是患者未遵守医嘱所致，而非与石膏固定技术有关。加强对患者及家属的石膏护理教育可能会减少计划外石膏更换的频率，从而减轻医疗系统的经济和时间负担。
二级——预后研究。
