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Abstract
Background Management of common childhood spiral tibial fractures, known as toddler’s fractures, has not significantly changed in recent times despite the availability of immobilisation devices known as controlled ankle motion (CAM) boots. We compared standard therapy with these devices on quality-of-life measures.
Methods A prospective randomised controlled trial, comparing immobilisation with an above-knee plaster of Paris cast (AK-POP) with a CAM boot in children aged 1–5 years with proven or suspected toddler’s fractures presenting to a tertiary paediatric ED in Perth, Western Australia, between March 2018 and February 2020. The primary outcome measure was ease of personal care, as assessed by a Care and Comfort Questionnaire (eight questions scored from 0, very easy, to 8, impossible) completed by the caregiver and assessed during three treatment time-points and preintervention and postintervention. Secondary outcome measures included weight-bearing status as well as complications of fracture healing and number of pressure injuries.
Results 87 patients were randomised (44 CAM boot, median age 2 (IQR 1.5–2.3), 71% male; 43 AK-POP, median age 2 (IQR 1.7–2.8), 80% male), a significant difference in the care and comfort score was demonstrated at all treatment time-points; with the AK-POP group reporting greater personal care needs on assessment on day 2, day 7–10 and 4-week review (all p≤0.001). Weight-bearing status was significantly different at day 7–10 (77.5% CAM vs 53.8% AK-POP, p=0.027). There was no difference in fracture healing or pressure areas between the two treatment groups.
Conclusions Immobilisation of toddler’s fractures in a CAM boot allows faster return to activities of daily living and weight-bearing without any effect on fracture healing.
Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12618001311246).
- paediatric emergency med
- paediatric injury
- paediatrics
- paediatric orthopadics
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All study data are stored in a single password protected database and hard copy data are being stored in accordance with WA Health Research Governance Policy and Procedures.
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Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All study data are stored in a single password protected database and hard copy data are being stored in accordance with WA Health Research Governance Policy and Procedures.
Footnotes
Handling editor Gene Yong-Kwang Ong
Correction notice Since this article was first published online minor grammatical changes have been made. The term men has been changed to male in the abstract section.
Contributors KB conceived and coordinated the study from inception to completion and was the principle author of the paper. SOB assisted with study design and education, data collection and ongoing study supervision throughout the trial. SG assisted with data collection. KS and MB supervised and provided expert advice throughout the study design and review of the final paper. NB was involved in study design and analysis of results.
Funding This study was funded by a PCH Foundation Project Grant (PMHF Grant ID: 9761). The funders of this study had no role in the study design, data collection, data analysis, data interpretation, writing of the study manuscript or decision for manuscript submission. The corresponding author (KB) had full access to all the data in the trial and had final responsibility for the decision to submit for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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