Prospective Evaluation of Cast Bivalving for Pediatric Distal Radius Fractures

Displaced pediatric distal radius fractures are treated with fracture reduction and cast immobilization. Currently, at our institution (and many others) radiographic assessment to determine acceptable fracture alignment and cast parameters is done immediately after cast application. However, afterward casts are often split on both sides along their length, in a process known as bivalving, prophylactically treating for post-traumatic soft tissue edema. While bivalving is felt to relieve pressure from the cast, it may also diminish the structural integrity of the cast. Although it is well-established that loss of fracture alignment is most common in the first few weeks after fracture reduction there have been no studies to evaluate any immediate changes to fracture reduction or cast parameters that may occur after bivalving. Thus, the goal of this study was to assess if pediatric distal radius fracture alignment was affected by cast bivalving by obtaining post-bivalve radiographs in addition to standard post-cast radiographs.

Inclusion criteria

• Guardian must be present
• Able/eligible to complete follow-up
• Initial injury within 72 hours
• Distal Radius fracture with or without distal ulna fracture
• Requiring non-operative management with molded cast

Exclusion criteria

• Open fractures
• Re-fractures
• Pathologic fractures
• Fractures associated with neurovascular injury
• Poly trauma incident
• Intubated patients or unable to verbalize symptoms of pain
• Preexisting medical history that effects musculoskeletal health