Prospective Evaluation of Cast Bivalving for Pediatric Distal Radius Fractures

Study Overview
=================
Brief Summary
-----------------
Pediatric patients with distal radius fractures are most commonly treated non-operatively with fracture reduction and cast immobilization. In order to prevent complications from increased swelling after the injury (or fracture manipulation) casts may be split along their length to relieve pressure. However, this can compromise the casts' structural integrity, predisposing fractures to loss of reduction. The goal of this study was to investigate if cast bivalving, or splitting the cast longitudinally on both sides, resulted in any immediate change to bony alignment and to assess if bivalving effected cast parameters associated with loss of reduction.

Detailed Description
-----------------
Displaced pediatric distal radius fractures are treated with fracture reduction and cast immobilization. Currently, at our institution (and many others) radiographic assessment to determine acceptable fracture alignment and cast parameters is done immediately after cast application. However, afterward casts are often split on both sides along their length, in a process known as bivalving, prophylactically treating for post-traumatic soft tissue edema. While bivalving is felt to relieve pressure from the cast, it may also diminish the structural integrity of the cast. Although it is well-established that loss of fracture alignment is most common in the first few weeks after fracture reduction there have been no studies to evaluate any immediate changes to fracture reduction or cast parameters that may occur after bivalving. Thus, the goal of this study was to assess if pediatric distal radius fracture alignment was affected by cast bivalving by obtaining post-bivalve radiographs in addition to standard post-cast radiographs.

Official Title
-----------------
Prospective Evaluation of Loss of Reduction and Cast Parameters Following Cast Bivalving for Pediatric Distal Radius Fractures

Conditions
-----------------
Distal Radius Fracture, Loss of Anatomical Alignment After Fracture Reduction

Intervention / Treatment
-----------------
* Radiation: Forearm anteroposterior and lateral plain radiograph


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Guardian must be present Able/eligible to complete follow-up Initial injury within 72 hours Distal Radius fracture with or without distal ulna fracture Requiring non-operative management with molded cast Exclusion Criteria: Open fractures Re-fractures Pathologic fractures Fractures associated with neurovascular injury Poly trauma incident Intubated patients or unable to verbalize symptoms of pain Preexisting medical history that effects musculoskeletal health

Ages Eligible for Study
-----------------
Minimum Age: 1 Year
Maximum Age: 17 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Radiation: Forearm anteroposterior and lateral plain radiograph|2 view plain film of forearm after valving a short arm cast.|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in reduction after bivalving | Change in fracture reduction of 2mm or 5 degrees in angulation on radiographs after bivalving | up to 24 hours | 
| Change in reduction at follow-up | Change in fracture reduction of 2mm or 5 degrees in angulation on radiographs at follow-up | up to 30 days | 
| Cast Index | Cast index, the ratio of sagittal to coronal width from the inside edges of the cast at the fracture site will be measured via radiographs. | through study completion, up to 2 years | 
| Gap Index | Gap index is a measure of space between the cast and skin measured as a ratio to the inside diameter of the cast, assessed at the level of the fracture on anteroposterior and lateral radiographs. | through study completion, up to 2 years | 
| Three Point Index | Three point index, a measure of space between the cast and skin at sites of the three point mold, with reference to the adequacy of reduction, assessed via the contact length of the proximal and distal fracture segments on anteroposterior and lateral radiographs. | through study completion, up to 2 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Cast, Pediatric, Cast Index, Distal Radius Fracture, Loss of Reduction, Bivalve