Plaster casts not needed for some childhood broken bones
Publication Date:16/04/2008
If you've ever had a plaster cast for a broken bone, you'll know how uncomfortable and awkward they can be. But new research shows that they may not always be needed for minor fractures in small children.
What do we know already?
One of the most common ways that children break bones is by stretching out a hand to protect themselves during a fall, causing a broken wrist. About 1 in 3 children who get a fracture have a broken wrist.
Because young children's bones are still soft, many of these breaks aren't serious. Young children often get a 'buckle fracture', where the bone doesn't break all the way through, but just buckles in on one side. Traditionally, doctors have treated these fractures with plaster casts from below the elbow to the hand. The child then has to go back to hospital after about three weeks, to have the cast taken off.
Some doctors think casts aren't needed for buckle fractures. In some hospitals, minor fractures of the wrist are treated with a rigid, removable splint that can be taken off at home, or even with soft bandages.
What does the new study say?
The researchers looked at four studies comparing traditional plaster casts with removable splints or bandages. The children in these studies were between 2 and 16 years old.
The researchers found that bones were just as likely to heal straight with a splint or bandage, compared with a cast. None of the children in the studies ended up with a deformed bone. And no children broke the bone again over the next six months.
The children, and their parents, preferred the removable splints or bandages. They were more convenient, particularly when the children needed to have a bath or shower. Children who'd had soft bandages instead of a plaster cast were more likely to say the bandages were comfortable, compared with children who'd had a cast. They could also move their wrists better, sooner after their accident.
The researchers said that the studies showed that traditional plaster casts were not necessary for buckle fractures. But the research wasn't clear enough to say what type of splint or bandage worked best.
Where does the study come from?
The study was produced by the Cochrane Collaboration. This independent, international body produces in-depth summaries of medical research.
How reliable are the findings?
The studies didn't look at any long-term problems. So we only know that the removable splints and bandages worked well in the weeks and months after the fracture.
One doctor has questioned whether removable splints are really a good idea. He says that young children are unlikely to keep the splint on. Writing in response to the new study, he said he thought children might take off a removable splint too soon, perhaps if they were embarrassed to wear it around their friends.
What does this mean for me?
If your child breaks a wrist, he or she will have an X-ray to see what sort of fracture it is. If it's a buckle fracture, your doctor might suggest a removable splint or bandage instead of a cast. Whether this happens will vary from hospital to hospital.
Many parents are worried that a splint or bandage won't work as well as a cast. But this study tells us that children's bones can heal straight without a plaster cast. You'll probably find a removable cast or bandage easier to cope with, and your child may find it more comfortable. Plus, so long as everything goes well, you won't need to go back to hospital to have it removed.
What should I do now?
If your doctor recommends a removable splint or bandage, you can be reassured that it should work. But it's important that children do keep them on for protection while their broken bone is still vulnerable. Ask your doctor what to do if your child's pain isn't getting better, or if your child won't wear the splint. And make sure you know how long your child should wear it for, and whether you need to come for a check-up afterwards.
From:
Abraham A, Handoll HHG, Khan T. Interventions for treating wrist fractures in children (Cochrane review). In: The Cochrane Library, Issue 2, 2008. Wiley, Chichester, UK.
News Archive
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
