Prescribing braces after forearm fractures does not decrease refracture rate

Abstract

Refracture is one of the most common complications of pediatric forearm fractures. One way to decrease this risk is to extend immobilization with a brace after the cast has been removed to allow for a range of motion exercises. The purpose of this study was to examine whether prescribing a brace after casting was discontinued decreased the risk of refracture. A retrospective, cohort study was performed at one level I trauma center. Girls under 10 years and boys under 12 years who sustained a forearm fracture from January 2013 to December 2018 were included. Patients with open fractures, fractures that required operative intervention, fractures involving the physis, fracture-dislocations, floating elbows, fractures in children with endocrine abnormalities, and fractures in patients lost to follow-up were excluded. The primary endpoint was a refracture within 6 months of the original injury that extended through the original fracture site. In total 2093 patients met the inclusion criteria. There were 19 refractures (0.9%). There was no statistically significant difference in the refracture rate between the braced (11/1091) and unbraced (8/1002) cohorts (Fisher exact value 0.65 at P < 0.05). The most common fracture type that went on to refracture was greenstick fractures. This large, retrospective study aimed to examine whether prescribing a brace had any significant effect on the refracture rate. Bracing after the cast is removed may help ease family anxiety and extend the period of immobilization while allowing for hygiene and range of motion, but it does not significantly decrease the rate of refracture.