Outcome measures
angulation
SECONDARY, COMPLICATION
Our primary outcome was change in loss of forearm rotation in comparison with the contralateral side and a comparison between the 2 casting methods. Secondary outcome measures were change in loss of flexion and extension of the elbow and wrist compared with the contralateral forearm, the Dutch version of the DASH and ABILHAND-Kids questionnaire, grip strength, and radiographic assessment of the radius and ulna. Cosmetics was measured as parents/child VAS 0–10 and surgeon VAS 0–10 (10 being the optimal score). An independent orthopedic surgeon (LD) measured the forearm rotation, flexion, and extension of the elbow and wrist in a standardized manner with the use of a goniometer. Before each measurement, the examiner ensured that the child was standing in an upright position. Meanwhile, the elbow was positioned firmly against the torso to eliminate compensating forearm rotation by using movements of the elbow and shoulder. The elbow was flexed at 90° with the forearm in mid-position and the wrist in neutral. Grip strength was determined using a JAMAR dynamometer (JLW Instruments, Chicago, IL, USA) on both sides and calculating a ratio of grip strength of the affected forearm/contralateral side. Furthermore, patients were asked to fill in the DASH and the ABILHAND-Kids questionnaires. The radiographic assessment included measurement of the coronal and sagittal angulation of the radius and ulna conducted by 1 of the authors (PE). Analyses were done using locally available analysis programs such as PACS and JiveX.To rule out potential effects of attrition we undertook a representability analysis. The included population was compared with the loss to follow-up population. This analysis showed no significant difference in age, sex, forearm rotation, or secondary outcomes such as ABILHAND-Kids questionnaire, VAS, and complication rate, concluding that the follow-up group was representative of the whole original study group (Representability of the lost to follow-up and included population. Values are mean (SD) unless otherwise statedCI = 95% confidence interval.ABILHAND-Kids questionnaire score 0–42. 42 is optimal score.VAS score 0–10. 10 is optimal score.