Waterproof casts for the management of upper limb fractures in children : a systematic review and meta-analysis.

IF 4.9 1区 医学 Q1 ORTHOPEDICS
Neel Badhe, Christopher Busby, Abbas See, Christopher Deacon, Tareq Altell, Ben J Ollivere, Ben A Marson
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引用次数: 0

Abstract

Aims: Upper limb fractures in children are often managed in casts. Waterproof casts which allow safe immersion in water may be used. These may improve comfort, convenience, and satisfaction when compared with standard casts. The aim of this review was to compare the efficacy, safety, and satisfaction of waterproof casts with standard casts in the management of upper limb fractures in children.

Methods: A systematic review of randomized controlled trials (RCTs) was conducted in September 2024. Comprehensive searches of Medline, PubMed, Cochrane CENTRAL, and EMBASE databases were performed. Studies were included which recruited children aged 0 to 18 years with upper limb fractures, which were managed in waterproof or standard casts. Patient-reported outcomes, functional outcomes, and complication rates were assessed.

Results: A total of five studies involving 390 children were included. Those managed with a waterproof cast reported significantly superior satisfaction with regard to comfort (mean difference (MD) 1.92 (95% CI 0.15 to 3.69); p = 0.034), itchiness (MD 0.21 (95% CI 0.00 to 0.43); p = 0.047), and overall child and parent satisfaction (MD 0.53 (95% CI 0.01 to 1.05); p = 0.048). Those managed with a waterproof cast also had significantly improved functional outcomes as measured by the Activities Scale for Kids-Performance (ASK-P) score, with a MD of 16.90 (95% CI 6.87 to 26.93; p = 0.001). There were no significant differences regarding heat or sweatiness, pain, return to recreational activities, unexpected returns for cast maintenance, radiological deformity, or skin problems.

Conclusion: Waterproof casts seem to provide an alternative to standard casts in the management of upper limb fractures in children. There were improved functional outcomes at the time of removal of the cast, improved comfort, and less itching. Pooling of the studies was limited due to the heterogeneity of the reporting of outcomes and the small sizes of the studies. Neither long-term outcomes, nor economic analysis based on healthcare-related quality of life, are available. A definitive RCT based on a core outcome set is required to confirm the efficacy and investigate the cost-effectiveness of waterproof casts in children.

防水石膏治疗儿童上肢骨折:系统回顾和荟萃分析。
目的:儿童上肢骨折通常采用石膏治疗。可以使用防水铸件,可以安全地浸泡在水中。与标准铸型相比,这些可以提高舒适度、方便性和满意度。本综述的目的是比较防水石膏与标准石膏在治疗儿童上肢骨折中的疗效、安全性和满意度。方法:于2024年9月对随机对照试验(RCTs)进行系统评价。综合检索Medline、PubMed、Cochrane CENTRAL和EMBASE数据库。研究纳入了0至18岁上肢骨折的儿童,这些儿童使用防水或标准石膏进行治疗。评估患者报告的结果、功能结果和并发症发生率。结果:共纳入5项研究,涉及390名儿童。使用防水石膏的患者报告舒适度满意度显著提高(平均差(MD) 1.92 (95% CI 0.15至3.69);p = 0.034)、瘙痒(MD = 0.21 (95% CI 0.00 ~ 0.43);p = 0.047),儿童和家长的总体满意度(MD = 0.53 (95% CI 0.01 ~ 1.05);P = 0.048)。通过儿童活动量表(ASK-P)评分测量,使用防水石膏治疗的儿童的功能结果也有显著改善,MD为16.90 (95% CI 6.87至26.93;P = 0.001)。在发热或出汗、疼痛、恢复娱乐活动、石膏维护意外复发、放射学畸形或皮肤问题方面没有显著差异。结论:在儿童上肢骨折的治疗中,防水石膏是标准石膏的另一种选择。在移除石膏时,功能结果得到改善,舒适度得到改善,瘙痒减少。由于结果报告的异质性和研究的规模较小,研究的合并受到限制。既没有长期结果,也没有基于医疗保健相关生活质量的经济分析。需要一项基于核心结果集的权威随机对照试验来确认防水石膏在儿童中的疗效并调查其成本效益。
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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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