Sat., 10/6/12 Pediatric Fractures, PAPER #111, 3:40 pm OTA-2012
SCRATCH (Self Cast Removal at the Child’s Home): Treatment of Stable Pediatric Forearm Fractures Using Home Removable Casts Compared With Traditional Cast Therapy: A Prospective Randomized Controlled Trial
Thomas W. Hamilton, MBChB; Lynne Hutchings, MRCS; Jennie Wakefield;
Joseph Alsousou, MRCS; Elizabeth Tutton; Emma Hodson; Clare Smith; Bridget Gray;
Susanna Symonds; Keith M. Willett, MD;
The Kadoorie Centre for Critical Care Research and Education,
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,
John Radcliffe Hospital, Oxford, United Kingdom
Purpose: Pediatric forearm fractures are common. We hypothesized that home removable flexible casts in the management of stable forearm fractures in children is clinically equivalent to rigid cast management, more cost-effective than the hospital removal of a rigid cast, and acceptable to both the patient and parent.
Methods: 317 children aged 2 to 16 years with distal forearm torus, minimally angulated greenstick or nondisplaced stable epiphyseal fractures (OTA 23–M/2.1, E/1.1, and E/2.1), were enrolled in this single center prospective randomized controlled trial. Patients with a flexible (SoftCast 3M) below-elbow cast with home removal were compared to those with a fiberglass below-elbow cast with hospital removal. The primary outcome was change in Childhood Health Assessment Questionnaire (CHAQ) score from baseline to 1 week post cast removal. Secondary outcomes were change in CHAQ and EQ-5D from baseline to 6 months postinjury, change in EQ-5D baseline to 1 week post cast removal, user satisfaction, and cost-effectiveness of management.
Results: 159 children were randomized to flexible casts and 158 to fiberglass cast. There were two crossovers from flexible to rigid casts. Follow-up by postal questionnaire 1 week after cast removal was 74% and 91% at 6 months by telephone. 56% were male and 39% fractured their dominant arm. Mean age was 9.3 years (standard deviation 3.2 years). There was no significant difference between groups in demographics, injury characteristics, or baseline CHAQ and EQ-5D scores. No significant difference was seen in change of baseline CHAQ score to score 1 week post cast removal between either group after allocation for potential confounders (P = 0.245). No significant differences were noted in CHAQ or EQ-5D scores at 6 months post injury in the flexible or rigid groups. The overall cost of treatment using home removable flexible casts was significantly less (P <0.05; $246; range, $231 to $402) compared with standard cast therapy ($400; range, $385 to $581). No difference was seen in satisfaction measures for both the cast and the general treatment between groups. Qualitative analysis identified that while the cast could be difficult to remove, there was a high level of satisfaction reported due to the convenience of home removal.
Conclusion: In children with stable distal forearm fractures, flexible below-elbow casts with home removal represent a safe, cost-effective alternative to traditional rigid fiberglass cast with hospital removal.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.