Above and Below-the-Elbow Plaster Casts for Distal Forearm Fractures in Children<sbt aid="1039044">A Randomized Controlled Trial</sbt>
Bibliographic record
Abstract
BACKGROUND: Closed fractures of the distal third of the forearm are the most common fractures of childhood, but the method of immobilization after closed reduction is controversial. This study was undertaken to determine whether below-the-elbow casts are as effective as above-the-elbow casts in immobilizing these types of fractures and to identify patient and treatment considerations that are related to loss of reduction. METHODS: We designed a blinded, randomized, controlled trial. The criteria for reduction and remanipulation were set a priori. The primary outcome measure was fracture immobilization as reflected by reangulation in the cast and by the need for remanipulation. Exploratory analysis with use of stepwise logistic regression analysis was undertaken to search for factors predictive of loss of reduction. RESULTS: A total of 102 children were enrolled in the study and were allocated to two groups: the above-the-elbow cast group (fifty-six children) and the below-the-elbow cast group (forty-six children). The mean age was 8.6 years, and sixty-one patients were boys. The groups did not differ with respect to the initial fracture angulation, postreduction angulation, reangulation during cast immobilization, and angulation of the fracture at the time of cast removal. In the above-the-elbow cast group, twenty-three (42%) of fifty-five children with adequate radiographs met the criteria for remanipulation compared with fourteen (31%) of forty-five children with adequate radiographs in the below-the-elbow cast group (p = 0.27); only four of these thirty-seven children actually underwent remanipulation. Children with fractures of both the radius and ulna (p = 0.01) and those with residual angulation after reduction (p = 0.0001) were at the highest risk of meeting the criteria for remanipulation. The rates of complications related to the cast did not differ between the groups. CONCLUSIONS: Below-the-elbow casts perform as well as above-the-elbow casts in maintaining reduction of fractures in the distal third of the forearm in children, and the complication rates are similar. Factors that are associated with a higher risk of loss of reduction include combined radial and ulnar fractures and residual angulation of the fracture after the initial reduction.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".