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Foam Padding in Casts Accommodates Soft Tissue Swelling and Provides Circumferential Strength After Fixation of Supracondylar Humerus Fractures

Seehausen, Derek A. BA; Kay, Robert M. MD; Ryan, Deirdre D. MD; Skaggs, David L. MD, MMM

Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0000000000000216
Trauma
Abstract

Background: Varying casting techniques are used after surgical treatment of pediatric supracondylar humerus fractures. The goals are to maintain fracture reduction, while accommodating soft tissue swelling and minimizing the risk of compartment syndrome.

Methods: A retrospective chart review of consecutive patients aged 0 to 14 years who underwent surgical treatment of supracondylar humerus fractures over a 9½-year period at a pediatric trauma center was performed. A new method of casting, in which one half inch sterile foam is applied directly to the skin and overwrapped by circumferential fiberglass, is presented and compared with traditional casts.

Results: A total of 541 consecutive patients were included. Foam had been used in 35% (190/541) of patients. Foam was used significantly more frequently in Gartland type 3 fractures (133/314 patients, 42%) than in type 2 fractures (57/227 patients, 25%) (P<0.001). Foam was also used more often in patients with preoperative neurovascular deficits (34/57, 60%) than in those without (156/484, 32%) (P<0.001). No patient in either group developed compartment syndrome postoperatively. Both patients in the study who required revision closed reduction and pinning were casted without foam, and one of these casts had been split. Reoperation was not associated with cast splitting (P=0.216) or foam use (P=0.543).

Conclusions: For postoperative immobilization of supracondylar humerus fractures we present a new method of placing foam directly on the skin, followed by circumferential fiberglass casting. This method offers the theoretical advantage of the strength of a circumferential cast, plus the benefit of allowing for swelling. Although the novel foam and cast combination was used in more severe fractures, results were comparable to traditional casts and may reduce the need for cast splitting.

Level of Evidence: Therapeutic—Level III.

Author Information

Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA

None of the authors received financial support for this study. No pharmaceutical or industry support was involved in the completion of this study. No external sources of funding were used in the completion of this study.

David L. Skaggs, MD, MMM, is a co-investigator for grants funded by POSNA and SRS (paid to Columbia University); consultant for Biomet and Medtronic, board member for the Growing Spine Study Group, Growing Spine Foundation and Medtronic Strategic and Advisory Board; Committee Chair for the Scoliosis Research Society; provides expert testimony in medical malpractice cases (<5% of income); receives payment for lectures including service on speakers' bureaus for Biomet, Medtronic, and Stryker; patent holder for Medtronic; receives royalties from Wolters Kluwer Health - Lippincott Williams & Wilkins, receives payment for the development of educational presentations for Stryker, Biomet and Medtronic and receives institutional support from Medtronic (fellowship program). All other authors declare no conflict of interest.

Reprints: David L. Skaggs, MD, MMM, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd. MS#69, Los Angeles, CA 90027. E-mail: dskaggs@chla.usc.edu.

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