Randomised controlled trial comparing immobilisation in above-knee plaster of Paris to controlled ankle motion boots in undisplaced paediatric spiral tibial fractures
| Autor: | Meredith L Borland, Simon Green, Kate Bradman, Sharon O'Brien, Natasha Bear, Katherine Stannage |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Orthotic Devices medicine.medical_specialty Activities of daily living Bone healing Critical Care and Intensive Care Medicine law.invention Weight-Bearing 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Surveys and Questionnaires 030225 pediatrics Activities of Daily Living medicine Humans Prospective Studies Toddler Personal care business.industry Significant difference Infant 030208 emergency & critical care medicine General Medicine Tibial Fractures Clinical trial Casts Surgical Child Preschool Ankle motion Emergency Medicine Physical therapy Female business |
| Zdroj: | Emergency Medicine Journal. 38:600-606 |
| ISSN: | 1472-0213 1472-0205 |
| DOI: | 10.1136/emermed-2020-210299 |
| Popis: | BackgroundManagement of common childhood spiral tibial fractures, known as toddler’s fractures, has not significantly changed in recent times despite the availability of immobilisation devices known as controlled ankle motion (CAM) boots. We compared standard therapy with these devices on quality-of-life measures.MethodsA prospective randomised controlled trial, comparing immobilisation with an above-knee plaster of Paris cast (AK-POP) with a CAM boot in children aged 1–5 years with proven or suspected toddler’s fractures presenting to a tertiary paediatric ED in Perth, Western Australia, between March 2018 and February 2020. The primary outcome measure was ease of personal care, as assessed by a Care and Comfort Questionnaire (eight questions scored from 0, very easy, to 8, impossible) completed by the caregiver and assessed during three treatment time-points and preintervention and postintervention. Secondary outcome measures included weight-bearing status as well as complications of fracture healing and number of pressure injuries.Results87 patients were randomised (44 CAM boot, median age 2 (IQR 1.5–2.3), 71% male; 43 AK-POP, median age 2 (IQR 1.7–2.8), 80% male), a significant difference in the care and comfort score was demonstrated at all treatment time-points; with the AK-POP group reporting greater personal care needs on assessment on day 2, day 7–10 and 4-week review (all p≤0.001). Weight-bearing status was significantly different at day 7–10 (77.5% CAM vs 53.8% AK-POP, p=0.027). There was no difference in fracture healing or pressure areas between the two treatment groups.ConclusionsImmobilisation of toddler’s fractures in a CAM boot allows faster return to activities of daily living and weight-bearing without any effect on fracture healing.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12618001311246). |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|