Children who break a wrist can heal as well in a splint as a cast, a study has discovered.
The advantage of a splint is that it can be removed occasionally to wash the arm or let it breathe or scratch itchy skin, according to co-author Kathy Boutis, an emergency-room pediatrician at the Hospital for Sick Children in Toronto.
One slight drawback: Kids can't brandish their plaster of Paris cast-encased arm for the time-honoured tradition of having it signed by friends.
The study, published Tuesday in the Canadian Medical Association Journal, looked at 92 children aged 5 to 12 who arrived in the hospital's emergency room from April, 2007, and September, 2009, with broken wrists.
The fractures were a clear break of the bone, and the bone could be a little bit bent or displaced for the child to qualify for the study. Forty-three kids received a splint and the remaining 49 were put in a cast.
"What we found was that essentially both groups performed very well, and this particular trial was not a trial to see if there was a difference between them, and certainly we were not interested to know if the splint was better," Dr. Boutis explained.
"We only cared to know if the splint was worse, because we know that the splint has so many advantages - and we know that these injuries heal so well. Better was not the question. We just wanted to make sure it was safe."
The youngsters had regular checkups and a physiotherapist examined them at the end of the healing period when the casts and splints were off, without knowing which device was used.
Dr. Boutis said the researchers found that the splint was at least as effective as the cast, and wrist movement and strength were similar.
"Our main thing was to make sure that overall their function was comparable, which it was, but otherwise, for example, we took X-rays to make sure that the fracture was stable and didn't move more in one group than the other group. And it hadn't."
"And then things like how the wrist moved, and how strong the wrist was, were very comparable in both groups."
The cost of a splint isn't covered by Ontario's health-care system. The prefabricated ones used in the study were provided by Benik Corp., and sell for about $45, Dr. Boutis said. A plaster of Paris cast is covered, while a lighter fiberglass cast option normally costs about $70.
It's not the first study on the topic. A comparison study published in Pediatrics about four years ago looked at minor fractures of the wrist, or buckle fractures, when there was not a clear break of the bone, Dr. Boutis said. As a result, splints are commonly used in that group of children.
"We've taken it one step further and looked at fractures that we know heal well, but are a clear break through the bone, and examined it in that group of children," Dr. Boutis said.
Likewise, minor ankle fractures don't get put into a cast any more at the Hospital for Sick Children if they're stable, but rather get put into a brace, she noted.
Dr. Boutis said children's bones heal differently than those of adults, and will also straighten as they heal.
"So if there's any bend to the bone that happens during a break, they grow and as they heal, the bone naturally straightens to quite an extensive degree, approximately about 10 degrees per year," she said.
Joe Hyndman of IWK Health Centre in Halifax has been treating kids' fractures for more than 35 years, and said orthopedic surgeons have been using different kinds of splints for some time.
Splints can be made with plaster of Paris as well - sort of half a cast - so patients can have some of the advantages of a splint without paying for a prefabricated one, he said.
Prefab splints would be an alternative if no one with the skill to craft one out of plaster of Paris is available, he noted.
"The good part of this is they've studied it appropriately and confirmed that you can do [it]this different way, and everything looks like it turned out all right."
Dr. Hyndman cautioned that it might be difficult to persuade hospital administrators to buy a stock of prefab casts in different sizes.
"I think the versatility of plaster is its beauty. You don't have to worry about sizes. You can make them any size you want."
Dr. Boutis said the new research is enough to change clinical practice fairly quickly at her hospital. "That's because we did it at our site and there's some confidence of the staff members around that particular issue."
Every parent thinks that their child is the most active, rambunctious child and they're worried the child will take off the splint or it won't be protective enough, she noted.
But that's not what her team found.
The research is being released at an opportune time. Dr. Boutis said it has been observed that peak times for broken bones among children are September, as they get back to school, as well as May and June.
The Canadian Press