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An Evidence-Based Approach to Casting and Orthosis Management of the Pediatric, Adolescent, and Young Adult Population for Injuries of the Upper Extremity

A Review Article

McVeigh, Kimberly H. MBA, OT, CHT*; Berger, Thomas G. DPT, PT, CHT*; Cudahy, Ryan MD; Dekker, Timothy M. MD; Brigham, Tara J. MLIS; Braxton, James C. OT, CHT*

doi: 10.1097/JSM.0000000000000718
General Review: PDF Only

Objective: Review the use of upper-extremity orthoses and casts after injuries to the wrist and hand in the pediatric, adolescent, and young adult population. The common injuries reviewed include pediatric distal radius fractures, scaphoid fractures, metacarpal fractures, mallet fingers, volar plate injuries of the proximal interphalangeal (PIP) joint, and ulnar collateral ligament (UCL) tears of the thumb metacarpophalangeal (MCP) joint.

Data Sources: We conducted a literature review from 1985 to 2016 of upper-extremity orthotic interventions. Non–English language citations and animal studies were excluded. Citations from retrieved studies were used to identify other relevant publications. This review included cases of common injuries to the upper extremity, which required orthotic intervention.

Main Results: Immobilization recommendations for nonsurgical pediatric distal radius fractures, nonsurgical metacarpal fractures, mallet fingers, and UCL tears of the thumb MCP include a removable orthosis. Nondisplaced scaphoid fracture orthosis recommendations include initial immobilization in a nonremovable short-arm thumb spica cast. Volar plate injuries of the PIP joint require buddy straps for healing.

Conclusions: The literature demonstrates the effectiveness of removable orthoses in healing, patient satisfaction, and time to return to activity after many common upper-extremity injuries. Removable orthoses should be considered an equal or superior treatment method to cast immobilization, immobilization of additional joints, or longer periods of immobilization.

*Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida;

Department of Family Medicine, Mayo Clinic, Jacksonville, Florida; and

Mayo Clinic Libraries, Jacksonville, Florida.

Corresponding Author: Kimberly H. McVeigh, MBA, OT, CHT, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (

The authors report no conflicts of interest.

Received March 26, 2018

Accepted December 19, 2018

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