Bivalved Versus Circumferential Cast Immobilization for Displaced XXXX : A Randomized Clinical Trial to Assess Efficacy and Safety.

@entity1 @entity174 @entity16 @entity2054 @entity531
BACKGROUND: The purpose of this study was to determine the effects of bivalved versus circumferential cast immobilization on maintenance of reduction and associated complications after closed reduction (CR) of radius and/or ulna @entity174 in @entity1 . METHODS: Two hundred two @entity1 with displaced radius and/or ulna @entity174 were randomized to either circumferential (n=101) or bivalved (n=101) long-arm casts after CR. The mean age was 10  3 years. There were no significant differences between groups in terms of age, sex, or initial @entity174 or angulation. Clinical and radiographic evaluations were performed at 1, 2, 4, and 6 weeks postreduction. Radiographic loss of reduction (LOR), need for remanipulation or surgery, and associated complications of @entity2054 , cast saw @entity531 were recorded. RESULTS: Overall, the median angulation of the radius and ulna @entity174 improved from 20 and 18 degrees to 3 and 2 degrees after CR, respectively. The median cast index after reduction was 0.78 in the bivalved group and 0.80 in the circumferential group. The median angulation of the radius and ulna was 8 and 1 degrees at 4 weeks, with no significant difference between groups. By the fourth week of follow-up, 70 @entity1 (34%)-35 bivalved and 35 circumferential-had radiographic LOR. Forty-seven @entity1 (23%)-23 bivalved and 24 circumferential-underwent remanipulation or surgical reduction and fixation. There were no significant differences between groups with respect to LOR rate or need for surgical treatment. One bivalved @entity1 sustained a cast saw injury, and 3 bivalved @entity1 had transient @entity16 . No @entity1 developed @entity2054 . CONCLUSIONS: Cast immobilization is effective in the majority of @entity1 after CR of displaced @entity174 . There were no significant differences in maintenance of reduction, need for surgery, or complications between bivalved or circumferential long-arm casts. LEVEL OF EVIDENCE: Level I-therapeutic.
