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Purpose: To determine whether splint material affects the success of non-operative management of pediatric forearm fractures treated with sugartong splints.
Methods: All patients aged 0-18 with a traumatic forearm fracture requiring reduction were enrolled prospectively and randomized to fiberglass or plaster sugartong splints. Patients with closed physes, open, pathologic, and non-displaced fractures not requiring reduction, or >1 week after injury were excluded. 230 patients met inclusion criteria, 90 randomized to plaster and 140 to fiberglass. Patients were stratified based on location of fracture: distal radius fractures (DRF), middle both bone forearm fractures (BBFFx), and proximal BBFFx. Outcomes after closed treatment were evaluated radiographically and clinically. Radiographic outcomes were based on residual deformity at initial and final follow-up. Clinical outcomes were assessed by conversion to surgery.
Results: Radiographic and clinical outcomes were similar between fiberglass and plaster splints. 97.4% of all patients were managed with closed treatment. Only 2.6% required conversion to surgery, 1.1% in the plaster cohort and 3.6% in the fiberglass cohort (p=0.41). No patients required re-reduction with sedation. At final follow-up, 32.5% of middle or proximal BBFFx and 1.3% of DRF healed in “unacceptable” alignment according to classically described guidelines.
Conclusions: There is no difference in the effectiveness of fiberglass vs. plaster sugartong splints for initial immobilization of pediatric BBFFx and DRF. Rates of conversion to surgery were lower in both groups than previously described. However, there was a trend toward treating “unacceptably” aligned forearm fractures non-operatively and more research is indicated to determine long-term clinical significance.