The
majority of paediatric forear
m fractures are treated using a circu
mferential splint, with prior
manipulation as necessary. Plaster of Paris is often chosen for its ease of application, cost and proven reliability.
m>Softcastm> is an alternative, providing a comfortable and water-resistant splint that can be removed without a plaster saw, and is in widespread use for immobilising buckle fractures. m>Softcastm> has not been recommended for acute unstable fractures. We established whether a m>Softcastm> splint could provide sufficient mechanical stability to control an unstable paediatric forearm fracture.
Methods
A laboratory study was undertaken to compare the 3 point (kinking) and 4 point bending, and torsion loads to defined clinical failure points withstood by standardised 4-wrap POP compared to m>Softcastm> splints with 6-wrap, 4 wrap and reinforced 4-wrap configurations.
Results
The load at clinically relevant failure of a 6-wrap m>Softcastm> forearm splint was 504 N in 4 point bending, 202 N in 3 point bending (kinking), and 11Nm in torsion (equalling 30.4%, 26% and 42.2% of the equivalent values for a circumferential 4-wrap POP). The 6-wrap m>Softcastm> was however stronger in all modes than a fibreglass-reinforced m>Softcastm> splint (previously recommended for acute fractures). Furthermore, the load to failure in all modes exceeds that which can be exerted by body weight in many paediatric patients.
m>Softcastm> demonstrated complete recovery of its original shape on unloading, whereas POP was permanently deformed. 6-wrap Softcast splints were 4% lighter than POP.
Conclusion
A 6-wrap m>Softcastm> splint provides adequate mechanical stability and protection for paediatric patients up to approximately 20 kg, avoiding high-risk activities. The primary risk is not of fracture angulation and loss of position, but temporary indentation of the splint, causing discomfort or pain. Considering its ease of removal, m>Softcastm> may be preferable for younger paediatric patients. Its cost may be offset by reducing the number and duration of hospital visits.
