Pain during Cast Wedging of Forearm Shaft and Distal Forearm Fractures in Children Aged 3 to 12 Years-A Prospective, Observational Study

Children
Florian FreisledererJ Mayr

Abstract

Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age. This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days. Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to...Continue Reading

References

Dec 14, 2004·Injury·A BebbingtonR Savage
Jan 18, 2005·Injury·Kaye E Wilkins
Sep 27, 2006·Journal of Pediatric Orthopedics. Part B·Joris J W Ploegmakers, Cees C P M Verheyen
May 16, 2008·Clinical Biomechanics·T BerberichJ Mayr
Aug 1, 2012·Paediatric Anaesthesia·UNKNOWN Association of Paediatric Anaesthetists of Great Britain and Ireland
Sep 21, 2013·Journal of Pediatric Orthopedics·Julie Balch SamoraWalter P Samora
Aug 30, 2014·Journal of Pediatric Orthopedics. Part B·Jaffer M KattanMauricio Silva
Apr 19, 2015·Current Opinion in Anaesthesiology·Markus WeissThomas Engelhardt
Oct 31, 2017·Journal of Children's Orthopaedics·S GaukelR N Vuille-Dit-Bille

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Methods Mentioned

BETA
X-ray
sedation

Software Mentioned

JMP

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