Faculty of Orthopaedic and Trauma

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    COMPARATIVE STUDY OF RE-DISPLACEMENT OF DISTAL FOREARM FRACTURES IN CHILDREN IMMOBILIZED IN ABOVE-ELBOW CAST VS BELOW-ELBOW CAST AT KORLE-BU TEACHING HOSPITAL.
    (GHANA COLLEGE OF PHYSICIANS & SURGEONS, 2024-03-26) LARVIE, PRINCE GEORGE
    INTRODUCTION Distal forearm fractures are among the commonest fractures seen in children. They typically are the result of fall on the outstretched hand during play. The mismatch between the rapid bone growth and mineral accrual, especially in the distal radius, makes the distal forearm susceptible to fractures from simple falls. These fractures are usually manipulated and stabilized in cast. The choice of cast for immobilizing distal forearm fractures-above elbow versus below elbow still remains controversial. There have been two systematic reviews with meta-analysis till date on the subject. They both recommended further studies on it. There is also paucity of published studies on the subject in West Africa. The literature suggests other factors may be more important in re-displacement of these fractures. AIM This study was to ascertain whether re-displacement in a below elbow cast is worse than in an above elbow cast in children with distal forearm fractures, managed at Korle-Bu Teaching Hospital. METHODS AND MATERIALS This was a non-blinded, randomized control trial, where 58 children between 4 and 13 years, attended to at Department of Orthopaedics, Korle-Bu Teaching Hospital, with closed displaced distal forearm fracture were assigned to one of 2 treatment groups, one receiving below-elbow cast and the other, above-elbow cast. Each child underwent manipulation of the fracture under conscious sedation in the Plaster Room. A below-elbow or an above-elbow POP backslab was applied. The pre- and post-manipulation angulation and apposition in the sagittal and frontal planes were assessed and recorded. A week later, the children came for a completion of the cast, before and after which the angulation and apposition, and the cast and three-point indices were recorded. The children were reviewed each week with new radiographs for 3 weeks. The radiographic parameters we measured again and complications noted and managed. Those who met the criteria for re-manipulation were manipulated. The data was analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20. The categorical data was presented with graphs and tables, and differences assessed with Chi-square analysis. Continuous variables were analyzed with student t-test, using difference of means and multiple regression analysis to ascertain association. RESULTS There were no differences between the means for the two-groups with respect to sagittal angulation change (0.76±0.84 vs 0.82±2.02, p=0.88), frontal angulation change (0.49±0.75 vs 0.40±0.69, p=0.64), sagittal apposition change (0.99±1.11 vs 0.83±0.90, p=0.56), and frontal apposition change (0.87±0.82 vs 1.01±1.21, p=0.60). Multiple regression analysis showed a significant positive association between sagittal angulation change [β (95% Confidence Interval): 6.83(0.45-13.21), p=0.036], and cast index. Stepwise regression modelling also showed a positive association between the cast index and frontal apposition change [β (95% Confidence Interval): 4.69 (0.30-9.08), p= 0.036]. CONCLUSIONS The study found no difference in re-displacement between the below-elbow and above-elbow cast groups, for the management of distal forearm fractures in children. It did however find the cast index as a predictor of re-displacement, when the cut-off was set at 0.80.