Best position of immobilisation in a greenstick fracture of the distal radius
Date First Published:
July 14, 2005
Last Updated:
July 14, 2005
Report by:
Pranam Patel, medical student (Manchester Royal Infirmary)
Three-Part Question:
in [a child aged 3-12] with [a greenstick fracture of the distal radius] should [the forearm be immobilised in the pronated, neutral or supinated position]
Clinical Scenario:
an eight year old child presents to the emergency department with a suspected wrist fracture. radiology confirms a greenstick fracture of the distal radius. treatment is with the application of a plaster of Paris cast, but in which position should the forearm be immobilised (pronated, neutral or supinated)
Search Strategy:
Medline 1966- June 2005
CINAHL 1982- June 2005
The cochrane library, issue 2, 2005
CINAHL 1982- June 2005
The cochrane library, issue 2, 2005
Outcome:
1 citation which was a high quality randomised control trial
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Dorsally angulated solitary metaphyseal greenstick fractures in the distal radius: results after immobilisation in pronated, neutral and supinated position Gupta RP Feb-90 Safat | 60 children, 20 randomly allocated to each group | prospective randomised control trial | re-displacement after immobilisation | angular displacement greatest in pronation group and least in the supination group |
Author Commentary:
fracure of the distal radius is a common injury in children. treatment is with the application of a plaster of Paris cast. this review has found that angular displacement after the application of a cast occurs less often when the forearm is immobilised in the supinated position.
Bottom Line:
forearm should be immobilsed in the supinated position
References:
- Gupta RP. Dorsally angulated solitary metaphyseal greenstick fractures in the distal radius: results after immobilisation in pronated, neutral and supinated position