A prospective RCT comparing the outcome of above-knee and below-knee pop cast application for isolated tibial shaft fractures in children

Abstract

Purpose: Above-Knee Cast has been standard treatment for treating tibial fractures in children. We conducted this study to evaluate the time of union, complication and cost of treatment between above- Knee and Below-Knee Cast groups in children with isolated tibial shaft fractures. Study Design: Sixty children of age 6 months-15 years were randomized into Above-Knee and Below-Knee Cast group, who were followed and compared; till 6 months from January 2012 to March 2013. 10 children (6 torus, 2 undisplaced, 2 displaced fractures) lost to follow up at 6 months and were analyzed with missing value data analysis at 6 months. Results: All fracture united (8.30±2.69 weeks in Above-Knee Cast, 7.70±2.54 weeks in Below-Knee Cast). The pre-reduction parameters were varus (2-8o), valgus (4-8o), anterior angulation (4-9o), Posterior angulation (2-10o), Internal Rotation (3-6o), External rotation (3-6o), shortening (6.46 mm). At 6 months, above parameters were 2.83o±0.85, 3.20o±0.44, 2.83o±1.32, 2.67o±0.84, 3.40o±0.54, 2.83o±0.75, 2.67±1.15mm respectively in Above-Knee group and 2.60o±0.84, 2.50o±0.52, 3.00o±1.00, 2.93o±1.32, 3.00o±1.41, 2.33o±0.57, 2.00±0.00mm respectively in Below-Knee group. Reinforcement requirement of plaster was higher in Below-Knee cast (p=0.014). There were no refractures, residual complications. Conclusions and clinical relevance: Below-Knee cast is as effective as Above-Knee Cast for treatment of Isolated tibial shaft fractures in child with superior ROM at knee and low cost (p