Results
angulation, loss of flexion–extension of the elbow, fractures, coronal radial angulation, mean loss of forearm rotation, ’ loss of rotation to 7 months (P = 0.02)
SECONDARY
38 of 47 patients (17 of 23 with AEC and 21 of 24 with BEC) responded to the follow-up invitation and were clinically and radiologically assessed for long-term follow-up. The mean length of follow-up was 7.5 (4.4–9.6) years. Baseline characteristics were similar between the 2 groups (Baseline characteristics of the population with non-reduced diaphyseal forearm fractures. Values are number of patients unless otherwise specifiedAEC = above-elbow cast.BEC = AEC with early conversion to below-elbow cast.Values in years are mean and (range)Consort patient flow diagram. Intervention was above-elbow cast (AEC) or AEC with early conversion to below-elbow cast (BEC)Our primary outcome, loss of forearm rotation, showed improvement in both groups over time, with no significant difference between the 2 groups. The AEC group went from a mean loss of rotation of 30° (SD 29) at 2 months of follow-up, to 23° (SD 22) at 7.2 months to 8° (SD 22) at 7.5 years of follow-up. The BEC group went from 31° (SD 24) loss of forearm rotation at 2 months, to 18° (SD 17) at 7.2 months, to 8° (SD 15) at 7.5 years of follow-up. There was no significant difference between the two groups at 7.5 years of follow-up. Subgroup analyses based on the amount of loss of rotation showed no significant difference in mean limitation of prosupination (Loss of forearm rotation of the fractured arm with subgroup analysis. Values are number of patients unless otherwise statedAEC = above-elbow cast. BEC = AEC with early conversion to below-elbow cast. CI = 95% confidence interval.Values are mean (SD)Significant change over time compared with the previous value in time (linear mixed-models analysis).To address missing data, linear mixed-model analyses were performed, which showed a decrease in loss of forearm rotation over time in both groups. In the BEC group, a significant decrease was found when comparing 2 months’ loss of rotation to 7 months (P = 0.02), and 7 months to 7 years (P < 0.001).Secondary outcomes (loss of flexion–extension of the elbow and wrist, PROMs, and grip strength) revealed no statistically significant differences between the 2 treatment groups (Data on primary and secondary outcomes at 7.5-year long-term follow-up of non-reduced diaphyseal forearm fractures. Values are mean (SD)AEC = above-elbow cast. BEC = AEC with early conversion to below-elbow cast. CI = 95% confidence interval.ABILHAND-Kids questionnaire score 0–42. 42 is optimal score.DASH score 0–100, 100 being the worst score.JAMAR ratio = grip strength affected wrist/collateral side.At long-term follow-up we found no statistically significant differences in radiographic outcomes between the 2 groups. There was an increase in coronal radial angulation observed in both groups over time and an increase in maximal bowing (Data on radiographic outcomes, angulation at final follow-up. Values are mean (SD) unless otherwise statedAEC = above-elbow cast. BEC = AEC with early conversion to below-elbow cast. AP = anteroposterior. CI = 95% confidence interval.Significant change over time compared with the previous value in time (linear mixed-models’ analysis).We also performed a subgroup analysis comparing 2 subgroups: age < 9 years and ≥ 9 years, combining the AEC and BEC groups. Our study showed a remaining mean loss of forearm rotation of 29° in patients ≥ 9 years of age after 7.5 years, compared with 5° in children < 9 years of age (mean difference –24°, CI –38 to –9.0). There was significantly more improvement of function in patients < 9 years of age to almost no impairment. All patients, regardless of age, improved their function over time.