Does bracing after casting make forearm refracture less likely?

The answer to this question appears to be no, according to a retrospective study in 426 children aged younger than 15 years who were treated nonoperatively at 3 tertiary pediatric hospitals for a forearm fracture in both bones. Investigators reviewed patients’ radiographs, including angulation, translation, and percent translation of both the ulna and radius. They documented the treatment course, number of days in a cast, and return to full activity for each fracture and, to document refractures, examined each medical record for 2 years following the initial injury.

Patients were divided into 3 groups based on treatment: casting only (CO), 111 patients; casting plus functional bracing less than 8 weeks (CFB < 8 wks), 259 patients; or casting plus functional bracing greater than or equal to 8 weeks (CFB ≥ 8 wks), 56 patients. Patients in the CO group were youngest (mean age 4.4 years), com- pared with 6.3 and 8.4 years, respectively, in the other 2 groups. The 3 groups did not differ significantly in how long they spent in a long arm cast, although time spent in a short arm cast did differ significantly: 24 days for the CO group, 21 for CFB less than 8 weeks and 29 for CFB greater than or equal to 8 weeks. Time before returning to full activity also differed significantly among the groups, with 61 days for CO, 81 days for CFB less than 8 weeks, and 143 days for CFB greater than or equal to 8 weeks.

Investigators found no association between refracture and initial fracture characteristics, such as age, translation, or the number of days in a brace. The over- all refracture rate was 4%, with median time to refracture varying from 3 months for the CO group, 4 months for CFB less than 8 weeks, and more than 8 weeks for the 1 fracture in the CFB greater than or equal to 8 weeks group. Although the study revealed that bracing for longer than 8 weeks does reduce risk of a refracture compared with limited (< 8 weeks) or no bracing, this difference did not reach statistical significance.

Thoughts from Dr. Farber

Bracing can be a nuisance and keeps children from returning to full activity for longer periods; children appear to be better off without bracing once the cast is off. Discuss this with your orthopedic colleagues if they insist on bracing.

Reference

1. Soumekh L, Sylvanus T, Karlen A, Wahl C, Huser AJ, Truong WH. Refracture rate of both bone forearm fractures: a retrospective comparison of casting alone versus casting and extended functional bracing. J Pediatr Orthop. 2021;41(5):267-272. doi:10.1097/BPO.0000000000001787