Allergic Contact Dermatitis in the Right Forearm Following Splint Application for Distal Radius Fracture: A Rare Case of Plaster Cotton Allergy.

Allergic contact dermatitis (ACD) after splint or cast application (plaster of Paris) is infrequently encountered in orthopedic and traumatology clinical practice. This case study aims to elucidate the identification of ACD after splint application, highlight the conditions that warrant vigilance, and outline the precautions and optional treatment methods available in such instances. A 56-year-old right-hand dominant female presented to the emergency department after a fall on her right hand, manifesting pain, swelling, and tenderness without neurovascular injury. Radiographs revealed a distal radius fracture, leading to the application of a plaster of Paris splint. Within one day, she returned to the emergency department with severe itching and burning in the right arm. The splint was removed, and a dermatology consultation confirmed ACD due to undercast cotton padding. After splint removal, the patient's fracture treatment continued using a shoulder-arm sling until the lesion healed. Topical antihistamine ointment and oral corticosteroids were prescribed. Regular follow-up revealed the healing and union of the fracture by the fifth week, with minimal residual skin color changes. This case underscores the importance of prompt diagnosis and appropriate treatment in managing such occurrences. A key takeaway is the crucial need to schedule a follow-up appointment with the patient within one day of applying the cast or splint. Skin problems can emerge rather than neurovascular issues following casts or splints. Educating patients on warning signs, including skin irritation, neurovascular deficits, and symptoms of compartment syndrome, ensures the timely identification of significant issues. Healthcare practitioners should inquire about patients' histories of allergic skin reactions, taking a proactive approach to prevent ACD through early intervention and preventive measures.

Conservative Management of the Ring and Little Finger Carpometacarpal Joint Dorsal Dislocations.

This is a case of right ring and little finger carpometacarpal joint dislocation managed with conservative care following early presentation and accurate identification of the injury. It is a rare injury that can be easily missed with the need for operative intervention if there is a delayed diagnosis. The dislocation was reduced and retained with an ulnar gutter splint using plaster of Paris extending from the mid-forearm to the metacarpophalangeal joints. Caution and repeated radiological assessment are advised to ensure that the reduction has been maintained. Follow-up at one week and four weeks post injury showed no pain or deformity, with a normal range of motion in the affected joints.

Long-term stability of hydroxyapatite bone phantoms for the calibration ofin vivox-ray fluorescence spectrometry-based systems of bone lead and strontium quantification.

Hydroxyapatite (HAp) phantoms have been proposed as an alternative to plaster of Paris (poP) phantoms for the calibration of x-ray fluorescence-based systems for thein vivoquantification of bone lead and strontium which employ a coherent normalization procedure. The chemical composition of the material becomes critical in the calculation, or omission, of the coherent correction factor (CCF) required in this normalization procedure. This study evaluated the long-term chemical stability of HAp phantoms. Phantoms were prepared and allowed to age for a two week period and over a seven year period in ambient conditions. The chemical composition of the phantoms was then assessed by powder x-ray diffraction. Two week old phantoms were found to be composed of HAp with only a small amount of contamination from CaHPO4·2H2O. Seven year old phantoms were found to have converted nearly completely to a carbonate-bearing apatite in the form of Ca10(PO4)6(CO3)0.75(OH)0.5indicating that the HAp phantom material likely reacts with carbon dioxide in air over time forming a carbonate-bearing apatite. The influence of this chemical conversion was assessed at the level of relevant cross-sections. Calibration under the assumption that the material is HAp when in fact it is a carbonate-bearing apatite would result in not more than a 0.2%-2% bias in the total mass attenuation coefficient within the photon energy range of 0-100 keV. Differential scattering cross-section for coherent scattering was found to differ between HAp and carbonate-bearing apatite by 0.9%-2% for both a 35.5 keV and 88.0 keVγ-ray. This variation in the differential scattering cross-section for coherent scattering may introduce a ca. 2% bias in the CCF used within the coherent normalization-based calibration procedure. Using HAp phantoms as calibrators thus requires acknowledgement of this conversion in chemical form and possible introduction of uncertainty into the calibration procedure.

Revolution in orthopedic immobilization materials: A comprehensive review.

Immobilization material has slowly revolutionized since 3000 BCE from traditional plaster to modern day synthetic casting tape, including other sustainable immobilization material. This revolution is driven by the search for superior casting material that possesses excellent mechanical and load-bearing properties, non-toxicity, excellent healing rates, patient satisfaction and eco friendliness. Even though the new materials have been evolved, the traditional plaster still remains a material of choice owing to its excellent skin conformability, low cost and availability. This paper aims to present a comprehensive review on the technique of immobilization, existing orthopedic immobilization (casting and splinting) materials and complications associated with immobilization (mainly casting) which aimed to assist the medical practitioners and researchers in casting material improvements and selection. Nine immobilization materials are comprehensively discussed for their desirable properties, drawbacks and the required improvements to the composition, along with the most common cast complications ranging from superficial pressure sores to compartment syndrome and Deep Vein Thrombosis. . This paper identifies that among the existing material, plaster casts are still highly used due to their cost benefit and the ability to fit patients into full body casts, while synthetic material is too rigid and has a higher probability of causing complications such as compartment syndrome and deep vein thrombosis. Patients show a higher preference in using synthetic casts for short term and body extremity casting as they are comparatively more comfortable. New materials such as Woodcast shows good promise but their mechanical characteristics and comfort are yet to be critically analyzed. However, there exists an imminent requirement to upgrade existing material as well as to introduce novel promising sustainable material for long term immobilization.

Comparison of two different ways to apply a circular plaster cast for distal radius fractures: biomechanical study.

INTRODUCTION: Although conservative treatment with circular plaster cast is the most commonly used method in distal radius fractures, the best method to apply it remains unclear. MATERIAL AND METHODS: Two frequently used configurations of circular plaster cast (with and without a splint) were selected to compare. Group C was applied only with circular bandages (three units) and group S with a splint (one unit) and over it, a circular bandage (two units). Both configurations had the same weight. Five prototypes of each group were built and mechanically tested. Three-point flexural tensile strength and maximum deflection were measured and compared. RESULTS: The previously splinted prototypes (group S) obtained higher tensile strength with the same weight (p < 0.05). DISCUSSION: No other study regarding strength and configuration of circular casts for distal radius fractures immobilization has been previously published, leading to a high variability in construction among orthopedic surgeons. Data confirms that applying a splint before circular bandage offers more mechanical resistance to the cast in flexion, with the same weight. CONCLUSION: Applying a splint before circular bandage for plaster casts used for distal radius fractures make them more resistant to usual forces.

In vitro Elution of Penicillin, Ampicillin, Tetracycline, Tulathromycin, and Florfenicol From Plaster of Paris Beads.

The objectives of this study were to report a recipe for making antibiotic impregnated Plaster of Paris (AI-PoP) beads using penicillin, ampicillin, tetracycline, tulathromycin, and florfenicol and to determine the in vitro elution rates of those antibiotics in the beads. The AI-PoP beads were made using Plaster of Paris powder, antibiotic, and water, cured for 24 h, sterilized by ethylene oxide, and stored up to 5 months before testing. For each antibiotic, 20 beads were combined with bovine serum in sterile tubes and incubated at 37°C on a rocker. Serum was replaced at intervals over the 14 days study period, and antibiotic concentrations were determined by high pressure liquid chromatography with mass spectrometry. Separately, in a proof-of-concept study, the growth of E. coli and T. pyogenes in eluent from 10 beads for each antibiotic was quantified by flow cytometry. Antibiotic was detected in AI-PoP bead eluent for 14 days for all but the ampicillin beads, for which antibiotic was detected for 8 days. The concentration of antibiotic in eluent was greater than the minimum inhibitory concentration (MIC) of tested bacteria for the entire study period for penicillin, tetracycline, tulathromycin, and florfenicol. The concentration of ampicillin remained greater than the MIC of E. coli for 4 days and T. pyogenes for 6 days. The colony forming units (CFU)/ml of live E. coli and T. pyogenes was reduced over a 72-h period by 1-3 log10 CFU, with the exception of tetracycline, which reduced CFU/ml of T. pyogenes by

Comparison of plaster-of-Paris casts and Woodcast splints for immobilization of the limb during serial manipulation and casting for idiopathic clubfoot in infants.

AIMS: The study was undertaken to compare the efficacy of Woodcast splints and plaster-of-Paris casts in maintaining correction following sequential manipulation of idiopathic clubfeet. METHODS: In this randomized prospective trial, 23 idiopathic clubfeet were immobilized with plaster-of-Paris casts and 23 clubfeet were immobilized with a splint made of Woodcast that encircled only two-thirds the circumference of the limb. The number of casts or splints needed to obtain full correction, the frequency of cast or splint-related complications, and the time taken for application and removal of the casts and splints were compared. RESULTS: The mean number of casts required to obtain full correction of the deformity (Pirani Score 0) was 4.35 (95% confidence interval (CI) 3.74 to 4.95) when plaster-of-Paris was used and 4.87 (95% CI 4.33 to 5.41) when the Woodcast splint was used (p = 0.190). The time required for application and removal of the Woodcast splint were significantly less than that required for application and removal of plaster-of-Paris casts (p < 0.001). Woodcast splint-related complications were not more frequent than plaster-of-Paris cast related complications. CONCLUSION: Though Woodcast splints covering two-thirds of the circumference of the lower limbs of infants were effective in maintaining the correction of clubfoot deformity during serial manipulation and casting treatment, the superiority of Woodcasts over plaster-of-Paris could not be established. Cite this article: Bone Joint J 2020;102-B(10):1399-1404.

Evolution of casting techniques in early-onset and congenital scoliosis.

Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 500 to 600) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation- Derotation- Flexion) casting.

Histologic Evaluation of Artificial Floors Under MTA and Nano-Filled Resin-Modified Glass Ionomer Used to Repair Furcation Perforations in Dogs.

Objective: This study aimed to compare the tissue reaction of two repair materials for furcation perforations, nano-filled resin modified glass ionomer (Nano-FRMGI) and mineral trioxide aggregate (MTA), used with or without an artificial floor. Methods: A total of 96 teeth in 6 dogs were used for this study. After access cavities, root canals were prepared and obturated with gutta percha using cold lateral condensation technique. Perforations were then created on the floors of the pulp chambers. The perforations divided into four groups n=24/group that were sealed with MTA alone, MTA with calcium sulphate artificial floor (CSAF), FRMGI alone and Nano-FRMGI with CSAF. All access cavities were filled with composite resin. Two dogs were sacrificed at 1, 3, and 6 month. The experimental tooth along with the surrounding alveolar bone were cut in block sections and histologically evaluated for tissue response. Data were analyzed by Chi-square (P≤0.05). Results: MTA and MTA with CSAF showed more bone and cementum apposition when compared to Nano-FRMGI at 6-month interval. MTA and MTA with CSAF showed less bone resorption, epithelium proliferation and inflammation compared to Nano-FRMGI at 6-month interval. Conclusion: MTA with CSAF or MTA-alone show better outcomes in the repair of pulp chamber floor perforation.

Phosphate removal from water using alginate/carboxymethylcellulose/aluminum beads and plaster of paris.

Phosphorus released in lakes due to agricultural water runoff causes eutrophication, deteriorating water quality and harming ecosystems. Two adsorbents were studied for the removal of phosphate from water: plaster of Paris powder and hydrogel beads produced using alginate, carboxymethylcellulose, and aluminum. The reaction kinetics, adsorption capacity, and ability to desorb were compared. Sorption of phosphate with either plaster of Paris or hydrogel beads was well described by the Langmuir model. In deionized water, hydrogel beads had a maximum sorption capacity of 90.5 mg  PO 4 3 - /g dry bead with an equilibration time of approximately 24 hr. Monovalent anions (e.g., chloride) did not affect phosphorus sorption onto hydrogel beads, whereas divalent anions (e.g., sulfate) hindered sorption. In deionized water, plaster of Paris (POP) powder has a maximum capacity of 1.52 mg  PO 4 3 - /g with an equilibrium time of less than 10 min. Sorbents can potentially be reused following phosphate desorption, and desorbed phosphate may be reused as fertilizer. At pH = 9.5, hydrogel beads desorbed up to 60% of the original amount of phosphate sorbed and lower amounts at lower pH. At pH = 2, POP powder desorbed only 35% of the initial phosphate sorbed, and desorption decreased with increasing pH. PRACTITIONER POINTS: The maximum sorption capacity of plaster of Paris is 1.52 mg  PO 4 3 - /g. The maximum sorption capacity of hydrogel beads is 90.5 mg  PO 4 3 - /g. Monovalent anions do not affect phosphorus sorption, and divalent anions hinder it by ≈36%. Sorption is well described by Langmuir isotherms (R2  > 0.98). Hydrogel beads desorb 60% of phosphorus at pH = 9, possibly allowing phosphorus reuse.

Performance of a biofilter with compost and activated carbon based packing material for gas-phase toluene removal under extremely high loading rates.

The main aim of this work was to evaluate the performance of a biofilter packed with a mixture of compost and activated carbon, for gas-phase toluene removal under very high loading rates. Plaster of Paris was used as a binder to improve the mechanical strength and durability of the packing media. The biofilter was operated continuously for a period of ∼110 days and at four different flow rates (0.069, 0.084, 0.126 and 0.186 m-3 h-1), corresponding to toluene loading rates of 160-8759 g m-3 h-1. The maximum elimination capacity (EC) achieved in this study was 6665 g m-3 h-1, while the removal efficiency (RE) varied from ∼70 to >95% depending on the loading rate tested. The biofilter was able to remove >99% of toluene using Pseudomonas sp. RSST (MG 279053) as the dominant toluene degrading biocatalyst.

Dip and drip, swipe or squeeze? The best method of draining water for optimal strength in a plaster of Paris backslab.

Plaster of Paris backslabs are used post-operatively to provide stability and protect repaired structures. We hypothesized that forceful expulsion of excess water during backslab construction could weaken the backslab by reducing the final gypsum content. Our aim was to compare the final dry mass and strength of backslabs prepared by three different techniques: 'dip and drip', 'swipe' and 'squeeze'. We applied an increasing force until the point of failure of the 30 backslabs prepared by the three methods. Backslabs prepared by swiping or squeezing away excess water were 9% lighter and 26% weaker and 13% lighter and 33% weaker, respectively, in comparison with simple drip drainage, and all results were statistically significant. We conclude that forceful drainage of excess water produces significantly weaker backslabs.

To assess the efficacy of socket plug technique using platelet rich fibrin with or without the use of bone substitute in alveolar ridge preservation: a prospective randomised controlled study.

AIM: The purpose of this study is to evaluate the efficacy of Platelet Rich Fibrin (PRF) as a socket plug with or without use of Plaster of Paris (POP) as bone substitute to preserve the alveolar ridge post-extraction. MATERIAL AND METHODS: A prospective randomised single blind controlled study, was conducted for 18 months from November 2014 to May 2016 on 48 patients requiring extraction. All teeth were extracted atraumatically using periotomes and luxators without raising mucoperiosteal flap. Sockets were randomly allotted to groups A, B and C. Group A sockets were chosen as control, where figure of eight suture was placed. In group B sockets, PRF obtained by centrifugation was used as a socket plug and stabilised with figure of eight suture. Group C sockets were filled with POP and then covered with PRF. The socket was then closed with a figure of eight suture. Patients were informed of need for 6 months follow-up. RESULTS: Ninety sockets in 48 patients were subjected to our study. We found that results in the sockets where we have grafted POP showed better ridge preservation and post-operative comfort even though the difference in ridge resorption between the three groups was not statistically significant. Powered by Editorial Manager® and ProduXion Manager® from the Aries Systems Corporation. CONCLUSION: Atraumatic extraction may minimise the post-operative pain and discomfort to patient as well as the post-extraction alveolar height and width changes. The use of PRF and/or bone substitute even though clinically contributes to better post-operative healing and minimal loss of alveolar width and height, the values were not statistically significant.

Ultrasound-Guided Intra-articular Injection of the Radio-ulnar and Radio-humeral Joints and Ultrasound-Guided Dry Needling of the Affected Limb Muscles to Relieve Fixed Pronation Deformity and Myofascial Issues around the Shoulder, in a Case of Complex Regional Pain Syndrome Type 1.

BACKGROUND: Complex regional pain syndrome (CRPS) occurs due to different pathophysiological mechanisms. Presently there is no description of definitive treatment that can resolve the especially recalcitrant motor issues of disability in CRPS type 1 (CRPS-1). CASE REPORT: We have herein described the successful management of motor disability with a multimodal approach in a patient with CRPS-1 that occurred as a result of a fracture sustained in the lower end of the radius. Sensory/sudomotor/vasomotor symptoms were relieved completely by medications and stellate ganglion block in 2 weeks. Ultrasound-guided dry needling secured near-complete improvement of shoulder and hand movements in 45 days. Ultrasound guided intra-articular (radio-ulnar and radio-humeral joint) injections with steroid reduced residual pain and improved forearm movements by 50% initially. The patient continued to receive regular sessions of dry needling, physiotherapy, and cognitive behavioral therapy. By the end of 1 year, the functions of the limb improved remarkably, as did the functional outcome scores. CONCLUSION: In this patient with CRPS-1, intra-articular injections with steroid reduced nociception in the affected local structures and sensitization in the nervous system; dry needling resolved the myofascial issues; sustained physiotherapy maintained the motor recovery; and behavioral therapy techniques addressed the cognitive and life stress issues. It was concluded that the presenting symptoms in this case were a consequence of interactions between humoral, nervous, and myofascial systems.

Plaster of Paris-Short History of Casting and Injured Limb Immobilzation.

Various materials have been used since ancient times to help immobilise fractures. In this review, we discuss the history and developments of these materials as well as plaster of Paris. There has been a recent trend away from non-operative management of fractures, and skills in the use of plaster of Paris are declining. For the successful treatment of patients, it is important to appreciate how plaster works, how it should be used, and what can go wrong. In this review, we also discuss principles of applications and complications of plaster of Paris.

Lower limb intracast pressures generated by different types of immobilisation casts.

AIM: To determine if complete, split casts and backslabs [plaster of Paris (POP) and fiberglass] generate different intracast pressures and pain. METHODS: Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS: A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL (P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs (P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL (P = 0.009). Intracast pressures were significantly lower in split casts (P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs (P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mmHg and greater (P = 0.001). Split fiberglass casts had significantly reduced pain levels (P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmHg. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mmHg and lower. CONCLUSION: Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.

Solid phase microextraction, sand flies, oviposition pheromones, plaster of Paris and siloxanes-What is in common?

Sand flies are natural hosts of various microorganisms. Due to their epidemiological importance, sand fly colonies are kept in laboratories to be studied in terms of their biology and vector/host/parasite interactions. In order to investigate the presence of oviposition pheromones in Nyssomyia neivai, experiments using Solid Phase Microextraction (SPME) were performed. However, siloxanes which is an external class of contamination, present in breeding containers made by plaster used to maintain sand flies in colonies, may be hindered the experiments.

Evaluation of Ponseti method in neglected clubfoot.

BACKGROUND: Gentle passive manipulation and casting by the Ponseti method have become the preferred method of treatment of clubfoot presenting at an early age. However, very few studies are available in literature on the use of Ponseti method in older children. We conducted this study to find the efficacy of Ponseti method in treating neglected clubfoot, which is a major disabler of children in developing countries. MATERIALS AND METHODS: 41 clubfeet in 30 patients, presenting after the walking age were evaluated to determine whether the Ponseti method is effective in treating neglected clubfoot. This is a prospective study. Pirani and Dimeglio scoring were done for all the feet before each casting to monitor the correction of deformity. Quantitative variables were expressed as mean ± standard deviation and compared between preoperative and postoperative followup using the paired t-test. Also, the relation between the Pirani and Dimeglio score, and age at presentation with the number of casts required was evaluated using Pearson's correlation coefficient. No improvement in Dimeglio or Ponseti score after 3 successive cast was regarded as failure of conservative management in our study. RESULTS: The mean age at presentation was 3.02 years (range 1.1 - 10.3 years). The mean followup was 2.6 years (range 2-3.9 years). The mean number of casts applied to achieve final correction were 12.8 casts (range 8 - 18 casts). The mean time of immobilization in cast was 3.6 months. The mean Dimeglio score before treatment was 15.9 and after treatment were 2.07. The mean Pirani score was 5.41 before treatment and 0.12 after treatment. All feet (100%) achieved painless plantigrade feet without any extensive soft tissue surgery. 7 feet (17%) recurred in our average followup of 2.6 years. CONCLUSIONS: Painless, supple, plantigrade, and cosmetically acceptable feet were achieved in neglected clubfeet without any extensive surgery. A fair trial of conservative Ponseti method should be tried before resorting to extensive soft tissue procedure.

Comparing the mechanical strength of hip spica cast between a conventional and a new method of application.

PURPOSE: The current technique of hip spica application is mostly based on a publication by Kumar (J Pediatr Orthop 1(1):97-99, 1981). We modified the technique of hip spica application in order to reduce the rate of breakage across the hip joint and designed this study to compare the strength between hip spica applied according to Kumar's technique and the new technique. METHODS: We created 12 hip spica casts with 24 hips according to Kumar's technique, and another 12 casts according to a new technique. The two types of spica were tested with a mechanical testing machine (Instron 3365 series) by using compression loading to failure in flexion, extension, abduction and adduction. Data were analysed in SPSS version 20.0. Comparison of means was done with an independent T test for normally distributed data and the Mann-Whitney test for skewed data. RESULTS: The new technique involved the creation of three slabs, instead of 14 slabs as described by Kumar. The loads to failure for hip spica cast applied according to the new technique were higher than those applied according to Kumar's technique, and the differences were statistically significant. The stiffness was also higher in spica casts applied with the new technique; the difference was not statistically significant under extension force. CONCLUSION: Hip spica applied with the new technique was stronger than that applied according to Kumar's technique based on load to failure testing. The new technique of application would potentially reduce the risk of cast breakage during the management of developmental dysplasia of the hip (DDH) and femur fracture in children.

Is softcast (3M) strong enough for potentially unstable paediatric forearm fractures?

INTRODUCTION: The majority of paediatric forearm fractures are treated using a circumferential splint, with prior manipulation as necessary. Plaster of Paris is often chosen for its ease of application, cost and proven reliability. Softcast is an alternative, providing a comfortable and water-resistant splint that can be removed without a plaster saw, and is in widespread use for immobilising buckle fractures. Softcast has not been recommended for acute unstable fractures. We established whether a Softcast splint could provide sufficient mechanical stability to control an unstable paediatric forearm fracture. METHODS: A laboratory study was undertaken to compare the 3 point (kinking) and 4 point bending, and torsion loads to defined clinical failure points withstood by standardised 4-wrap POP compared to Softcast splints with 6-wrap, 4 wrap and reinforced 4-wrap configurations. RESULTS: The load at clinically relevant failure of a 6-wrap Softcast forearm splint was 504N in 4 point bending, 202N in 3 point bending (kinking), and 11Nm in torsion (equalling 30.4%, 26% and 42.2% of the equivalent values for a circumferential 4-wrap POP). The 6-wrap Softcast was however stronger in all modes than a fibreglass-reinforced Softcast splint (previously recommended for acute fractures). Furthermore, the load to failure in all modes exceeds that which can be exerted by body weight in many paediatric patients. Softcast demonstrated complete recovery of its original shape on unloading, whereas POP was permanently deformed. 6-wrap Softcast splints were 4% lighter than POP. CONCLUSION: A 6-wrap Softcast splint provides adequate mechanical stability and protection for paediatric patients up to approximately 20kg, avoiding high-risk activities. The primary risk is not of fracture angulation and loss of position, but temporary indentation of the splint, causing discomfort or pain. Considering its ease of removal, Softcast may be preferable for younger paediatric patients. Its cost may be offset by reducing the number and duration of hospital visits.