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Trial registered on ANZCTR
Registration number
ACTRN12611000101987
Ethics application status
Not yet submitted
Date submitted
26/01/2011
Date registered
31/01/2011
Date last updated
31/01/2011
Type of registration
Prospectively registered
Titles & IDs
Public title
Long Arm Casting Versus Splinting After Manipulation of Distal Third Radius Fractures in Children
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Scientific title
Pediatric Distal Third Radius Fractures Treated with Long Arm Casting Versus Sugar Tong Splinting : A Comparison of Re-reduction Rates
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Secondary ID [1]
253484
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Auckland District Health Board - ADHB5006
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Distal Radius Fractures
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Condition category
Condition code
Musculoskeletal
259174
259174
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0
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Other muscular and skeletal disorders
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Injuries and Accidents
259184
259184
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0
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Fractures
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Sugar Tong Splint. A sugar tong splint is made of paris of plaster and goes along the posterior aspect of the elbow and extends along the front and back of the forearm and wrist. The sides of the forearm and wrist are left free to allow for swelling. The splint is wrapped with an elastic bandage and immobilizes the elbow, forearm, and wrist. This will be administered by the on call registrar in the emergency department at the time of the initial consultation.
The elastic bandage about the sugar tong splint will be tightened at week 1 if the splint has loosened. The splint will then be changed to an above elbow cast at the 2 week visit assuming no loss of reduction. This cast will be placed by the clinic nurses in fracture clinic. The cast will be maintained for 3-4 weeks.
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Intervention code [1]
257918
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Treatment: Devices
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Comparator / control treatment
Above Elbow Casting. An above elbow plaster of paris cast will be placed by the on call orthopaedic registrar in the emergency department at the time of the initial consultation. This plaster goes around the entire arm from the upper arm through the hand to provide rigid, circumferential immobilization of the affected arm. The cast will be left on for a total of 5-6 weeks.
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Control group
Active
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Outcomes
Primary outcome [1]
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Remanipulation rates. X-rays of the fractured wrist will be taken at 1,2, and 6 weeks after initial manipulation and immobilization. These x-rays will be evaluated by the primary investigator. If there is angulation of >20 degrees on either the AP or lateral x-ray of the wrist, the patient will need to undergo remanipulation of the wrist under general anesthesia.
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Assessment method [1]
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Timepoint [1]
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1, 2, and 6 weeks after initial manipulation and immobilization
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Secondary outcome [1]
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Cast Complications. Patients and parents will be given a questionnaire form at the 6 week visit asking if they 1) ever had their cast split during the treatment period due to the cast being too tight and 2) needed the cast to be replaced or overwrapped due to the cast loosening or breaking. In addition, patients and parents will be asked the same questions during their 1, 2, and 6 week visits by the orthopaedic registrar/fellow that evaluates them in clinic.
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Assessment method [1]
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Timepoint [1]
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1,2, and 6 weeks after initial manipulation and immobilization
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Eligibility
Key inclusion criteria
Pediatric patients age 3-14 years old that 1) are diagnosed with distal third radius fractures with or without associated ulna frctures, 2) require closed reduction of the fracture, 3) are treated with closed reduction at Starship Childrens Hospital, and 4) informed consent is obtained.
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Minimum age
3
Years
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Maximum age
14
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1) Open fractures, 2) fractures manipulated outside of Starship Childrens Hospital, 3) nondisplaced fractures or those fractures not requiring reduction, and 4) any irreducible fracture requiring open reduction and/or internal fixation or percutaneous wiring.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Potential participants in the study will be identified in the emergency department by the orthopaedic registrar on call. Patients qualifying for the study will be given information sheets regarding the study by the emergency department nurses and the orthopaedic on call registrar will discuss the study with the patients and parents. If a patient decides to participate in the study, they will be treated with manipulation and either casting or splinting.
Prior to starting the study, a computer generated randomized sequence of interventions (cast or splint) will be performed. Based on this randomized sequence, patients will then be treated with either a splint or a cast as they are enrolled into the study. 100 sealed opaque envelopes will be marked 1-100 and a piece of paper stating either “cast” or “splint” will be placed inside each envelope as determined by the randomized sequence. These envelopes will be made by an independent person not involved in the study so that the order is not known to any of the treating physicians. The on call registrars enrolling patients will not know the method of treatment until patients have agreed to participate in the study and the envelope has been opened.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Prior to starting the study, a computer generated randomized sequence of interventions (cast or splint) will be performed. Based on this randomized sequence, patients will then be treated with either a splint or a cast as they are enrolled into the study. 100 sealed envelopes will be marked 1-100 and a piece of paper stating either “cast” or “splint” will be placed inside each envelope as determined by the randomized sequence. These envelopes will be made by an independent person not involved in the study so that the order is not known to any of the treating physicians. The on call registrars enrolling patients will not know the method of treatment until patients have agreed to participate in the study and the envelope has been opened.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/03/2011
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
100
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
3159
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New Zealand
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State/province [1]
3159
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Funding & Sponsors
Funding source category [1]
258394
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Hospital
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Name [1]
258394
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Starship Childrens Hospital
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Address [1]
258394
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Department of Pediatric Orthopaedics
2 Park Road
Grafton
Auckland, New Zealand
1023
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Country [1]
258394
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New Zealand
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Primary sponsor type
Hospital
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Name
Starship Childrens Hospital
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Address
Department of Pediatric Orthopaedics
2 Park Road
Grafton
Auckland, New Zealand
1023
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
257536
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
260368
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Ethics committee address [1]
260368
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Ethics committee country [1]
260368
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Date submitted for ethics approval [1]
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25/10/2010
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Approval date [1]
260368
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Ethics approval number [1]
260368
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Summary
Brief summary
The current standard of treatment following closed reduction of pediatric distal third radius fractures involves the placement of a well molded cast to maintain reduction. Casts provide rigid, circumferential immobilization. Because of the fixed diameter of the cast, there is minimal ability for the cast to accomodate fluctuations in soft tissue swelling that occurs after an acute injury. In the acute phase, casts can cause compression of neurovascular structures if wrapped too tightly. As the swelling resolves, the cast loses its ability to maintain fracture reduction due to a loss of contact between the cast material and the extremity. Studies have shown up to a 35% re-reduction rate in pediatric distal third radius fractures after manipulation and casting. This study is designed to investigate if the application of a sugar tong splint with an elastic bandage immediately following closed reduction will lead to a decrease in the rereduction rate. A sugar tong splint with an elastic bandage is capable of accomodating changes in soft tissue swelling and should provide enough stability to maintain fracture reduction. The hypothesis is that the sugar tong splint will lead to a reduction in remanipulation rates.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Kenneth Huh
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Address
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Department of Pediatric Orthopaedics
2 Park Road
Grafton
Auckland, New Zealand
1023
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Country
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New Zealand
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Phone
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+64 (0)22 658 4355
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Kenneth Huh
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Address
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Department of Pediatric Orthopaedics
2 Park Road
Grafton
Auckland, New Zealand
1023
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Country
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New Zealand
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Phone
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022 658 4355
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Interventions for treating wrist fractures in children.
2018
https://dx.doi.org/10.1002/14651858.CD012470.pub2
N.B. These documents automatically identified may not have been verified by the study sponsor.
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