Cast Versus Splint in Children With Acceptably Angulated Wrist Fractures

Study Overview
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Brief Summary
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The study will compare the effectiveness of a prefabricated wrist splint with thermoplast reinforcements versus a short arm cast in skeletally immature children. The hypothesis is that the commercially available wrist splint is at least as effective as traditional casting with respect to recovery of physical function.

Detailed Description
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Acceptability angulated wrist bone fractures in children carry an excellent long-term prognosis because of the unique capacity of skeletally immature bones to heal via remodeling. Their management varies widely and there is virtually no scientific evidence supporting one treatment modality over another. Importantly, the most common treatment modality of cast application for four to six weeks is associated with many inconveniences. There are commercially available wrist splints that offer a more convenient alternative. Wrist splints likely have comparable immobilization and symptom relief, while simultaneously allowing for easier bathing and less reliance on subspeciality care. Preliminary adult evidence suggests that, in a comparable adult fracture, splinting may offer a safe alternative to casting, with earlier resumption of the usual activities. However, this treatment modality needs to be compared to the traditional casting management in the pediatric population before it can be recommended for clinical practice. This study will be the first to challenge the current practice of routine casting and compare it to a commercially available wrist splint with respect to recovery of physical function in children with acceptably angulated wrist fractures. In addition, standardized treatment of these fractures with a splint may be associated with lower morbidity, reduced use of health care resources, and have the potential for cost savings. This study will compare, in skeletally immature children, the functional outcomes that result from treatment with a prefabricated wrist splint versus a short arm cast in acceptably angulated distal radius fractures. Secondly, the cost-effectiveness of the splint relative to the cast will be evaluated.

Official Title
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Cast Versus Splint in Children With Minimally Angulated Fractures of the Distal Radius: a Randomized Controlled Trial.

Conditions
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Distal Radius Fractures

Intervention / Treatment
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* Device: Fiberglass short arm cast
* Device: Prefabricated wrist splint


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Skeletally immature children. Children must have a bone age of ≥ 5 years of age. Less than or equal to 15° angulation in the sagittal plane and ≤ 0.5 cm displacement in the frontal plane. Therefore, all skeletally immature children ≥ 5 years and with a bone age of ≤ 11 years who present to the ED of HSC with acute distal metaphyseal radius +/- ulnar fractures that meet criteria for acceptable angulation and displacement will be eligible for enrollment. Exclusion Criteria: Age < 5 years or > 12 The following diagnoses of distal radius fracture: buckle fracture, growth plate fractures of any kind, distal radius metaphyseal fractures with greater than 15° of angulation in the sagittal plane and/or more than 0.5 cm of displacement in the frontal plane. All open fractures which require a surgical debridement. All children at risk for pathological fractures such as those with congenital or acquired generalized bony disease. Stricter immobilization and a different prognosis may be applicable to this population.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br> | Device: Fiberglass short arm cast<br>* Cast will be applied for a 4-week period<br>|
| Experimental: 2<br> | Device: Prefabricated wrist splint<br>* Splint will be applied for a 4-week period<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified performance Activities Scale for Kids (ASKp) score |  | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Angulation and/or displacement |  | 1 and 4 weeks | 
| Pain |  | 1 and 4 weeks | 
| Duration of immobilization device |  | 1 and 4 week follow-up visits | 
| Grip Strength |  | 6 week follow-up visit | 
| Range of Motion |  | Week 6 | 
| Patient Preference for their Device |  | Week 6 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pediatrics, wrist fractures, casting, wrist splint