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Topic:

Casting

Issue:

Forearm

Category:

Trauma

Title:

The Pressure Is on: Dorsal Versus Volar Univalves for Long-arm Casts

Author:

Udall, Dallyn DO; Zimmerman, Remy BS; Bastrom, Tracey MS; Schlechter, John DO

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p e15-e19, DOI: 10.1097/BPO.0000000000002521

Level Of Evidence:

II

# of Patients:

1

Study Type:

Prospective comparative study

Location:

Not specified

Summary:

This study compares the effects of dorsal versus volar univalve long-arm casts on volar skin surface pressure (SSP) in adults, hypothesizing that the volar univalve technique reduces SSP more effectively.

Methods:

Procedure: A 100-mL saline bag attached to an arterial line pressure transducer was placed between a long-arm cast and the skin along the volar forearm. Interventions: Fourteen casts applied by an experienced orthopaedic technologist, randomly assigned to receive either a volar or dorsal univalve. Stages: Four stages measured the change in SSP: univalve alone, with a 3-mm spacer, with a 6-mm spacer, and with bivalve. Statistical Analysis: Mann-Whitney U test for data comparison.

Exclusions:

Not specified

Results:

Volar vs. Dorsal Univalve: Volar univalve significantly reduced SSP compared to dorsal in all stages. Stage I: 32.00 mm Hg vs. 20.43 mm Hg (P=0.001) Stage II: 45.14 mm Hg vs. 38.00 mm Hg (P=0.026) Stage III: 56.53 mm Hg vs. 49.00 mm Hg (P=0.001) Bivalve: No significant difference between groups after bivalve application (P=0.318).

Conclusions:

A volar univalve with a 6-mm spacer provides the greatest reduction in volar SSP while maintaining the cast's structural integrity, outperforming both dorsal univalve and bivalve approaches.

Relevance:

Limitations:

Perspective:

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