There were fewer treatment failures, defined as early or problematic removal of wires or remanipulation for early loss in position, after surgery (surgery 20/124 cast only 41/129 4 studies very low‐quality evidence). One study (123 children) reported similar ABILHAND‐Kids scores indicating normal physical function at six months (mean scores: surgery 41.9 cast only 41.4) low‐quality evidence. Short‐term functional outcome data were unavailable. Where reported, above‐elbow casts were used. Surgical fixation with percutaneous wiring and cast immobilisation versus cast immobilisation alone after closed reduction of displaced fractures (5 studies, 323 children) One study found treatment with an above‐elbow cast cost three times more in Nepal. One study (85 children) found less pain at one week for below‐elbow casts low‐quality evidence. There was little difference in requiring physiotherapy for stiffness (179 children, 2 studies) very low‐quality evidence. Recovery time and overall numbers of children with minor complications were not reported. There was no refracture or compartment syndrome at six months (215 children 2 studies). Overall treatment failure data are unavailable, but nine of the 11 remanipulations or secondary reductions (366 children, 4 studies) were in the above‐elbow group very low‐quality evidence. One study (66 children with minimally displaced both‐bone fractures) found little difference in ABILHAND‐Kids scores (0 to 42 no problems) (mean scores: below‐elbow 40.7 above‐elbow 41.8) very low‐quality evidence. Short‐term physical function data were unavailable but very low‐quality evidence indicated less dependency when using below‐elbow casts. One UK study found lower healthcare costs for home removal.īelow‐elbow versus above‐elbow casts for displaced or unstable both‐bone fractures (4 studies, 399 children) One study (80 children) found greater parental satisfaction in the home group low‐quality evidence. There was no evidence of a difference in pain at four weeks (233 children) low‐quality evidence. ![]() Recovery time and number of children with minor complications were not reported. One study found no serious adverse effects at six months (288 children). There were five treatment changes (home 4/197 hospital 1/200 2 studies very low‐quality evidence). One study (233 children) found full restoration of physical function at four weeks low‐quality evidence. ![]() Removal of casts at home by parents versus at the hospital fracture clinic by clinicians (2 studies, 404 children, mainly buckle fractures) More bandage‐group participants found their treatment convenient (39 children). Evidence was absent, insufficient or contradictory for recovery time, wrist pain, children with minor complications, and child and parent satisfaction. Two studies (139 children) reported no serious adverse events at four weeks. Eight children changed device or extended immobilisation for delayed union (bandage 5/90 cast 3/91 3 studies) very low‐quality evidence. One study (53 children) reported more children had no or only limited disability at four weeks in the bandage group very low‐quality evidence. Soft or elasticated bandage versus below‐elbow cast for buckle or similar fractures (4 studies, 273 children) Two studies estimated lower healthcare costs for removable splints. Evidence was absent (recovery time), insufficient (children with minor complications) or contradictory (child or parent satisfaction). One study (50 children) found no between‐group difference in pain during treatment very low‐quality evidence. One study (87 children) reported no refractures at six months. Thirteen children needed a change or reapplication of device (splint 5/225 cast 8/219 4 studies) very low‐quality evidence. ![]() One study (66 children) reported similar Modified Activities Scale for Kids ‐ Performance scores (0 to 100 no disability) at four weeks (median scores: splint 99.04 cast 99.11) low‐quality evidence. Removable splint versus below‐elbow cast for predominantly buckle fractures (6 studies, 695 children) Below we consider five prespecified comparisons: All studies were at high risk of bias, mainly reflecting lack of blinding. Eight studies recruited buckle fractures, five recruited buckle and other stable fractures, three recruited minimally displaced fractures and 14 recruited displaced fractures, typically requiring closed reduction, typically requiring closed reduction. Typically, trials included more male children and reported mean ages between 8 and 10 years. ![]() Of the 30 included studies, 21 were RCTs, seven were quasi‐RCTs and two did not describe their randomisation method.
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