[The art of cast wedging in children and adolescents].

Abstract

Objective: Correction of pediatric fractures by cast wedging to achieve acceptable positioning for conservative fracture management. Efficient and convenient treatment to avoid invasive manipulation or hospitalization.

Indications: Fractures of distal forearm shaft or distal metaphyseal forearm. Tibial shaft fractures from midshaft to distal metaphyseal region.

Contraindications: Proximal and middle forearm fractures. Complete dislocation. Articular fractures. Very young children (compliance problems). Open fractures.

Surgical technique: Immediate cast application for fracture treatment as usual. After 8-10 days wedging of the cast at concavity of fracture site leads to gentle fracture reduction within a few days.

Postoperative management: Depending on the age of the patient and location of the fracture, weekly visits to look for any discomfort or pain while cast treatment after wedging. Depending on the age of patient, duration of the cast is 4-6 weeks.

Results: A recent analysis of 199 fractures in Sankt Pölten (average age 8.9 years) showed low refracture rates. In only 2 cases did unsuccessful wedging lead to surgical treatment (proximal radius-elastic stable intramedullary nailing [ESIN], distal tibial metaphysis-K-wires). Furthermore, refracture after cast removal occurred in 4 out of a total of 78 greenstick fractures of the radius (refracture rate 5%, well below the usual figures reported in the literature). The treatment goal was achieved with cast wedging in 96% of the patient population.