Robert Jones bandage versus cast in the treatment of distal radius fracture in children: A randomized controlled trial / 中华创伤杂志(英文版)

PURPOSE@#The present study aimed to treat fractures of the distal end of the radius in children with Robert Jones (RJ) bandage. The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence, child comfortability, and family satisfaction.@*METHODS@#The study was a randomized controlled non-inferiority clinical trial including children with recent (less than 5 days) fractures at the distal end of the radius OTA/AO 23-A2, which is usually treated conservatively. Those with open fractures, pathological fracture, severely displaced fracture that needs reduction or multiple injuries were excluded. The participants were divided randomly into 2 groups according to the treatment modalities. Group 1 was treated by plaster of Paris cast (the control group), and Group 2 by modified RJ bandage (the trial group). The difference between the 2 groups was found by the Chi-squared test. The difference was considered statistically significant when the p value was less than 0.05.@*RESULTS@#There were 150 children (aged 2 - 12 years, any gender) included in the study, 75 in each group. The complications occured in 5 (3.3%) cases only, pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2. There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment (p = 0.649). Children treated by RJ bandages were more comfortable than those treated by the cast (97.3% vs. 73.3%, p < 0.001) with a statistically significant difference between them. Contrary to that, the families were more satisfied with the cast than RJ bandage (88.0% vs. 81.3%), but without a statistically significant difference (p = 0.257).@*CONCLUSION@#RJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.

An Upgrade of the International Hip Dysplasia Institute Classification for Developmental Dysplasia of the Hip

Background@#The purpose of the current study was to upgrade the International Hip Dysplasia Institute (IHDI) classification of developmental dysplasia of the hip (DDH). @*Methods@#The upgrading was suggested by adding the state of the acetabulum (type A for the normal acetabulum and type B for the dysplastic one). The pelvic radiographic films of 110 children suspected to have DDH were used by three observers to sort out the hips into grades according to the original form and the suggested upgraded one subsequently. @*Results@#The interobserver reliability between the observers improved from a good level (intraclass correlation coefficient [ICC], 0.885; 95% confidence interval [CI], 0.856–0.909) with the original form to an excellent level (ICC, 0.919; 95% CI, 0.898–0.936) with the upgraded form. When the upgraded form was used, only the grade 1 hips were divided into types A and B, while those classified as grades 2, 3, and 4 were all graded as type B only. @*Conclusions@#The IHDI classification of DDH can be upgraded into grade 1A, grade 1B, grade 2, grade 3, and grade 4.