Short-arm plaster vs fiberglass casts for displaced pediatric distal radius fractures: a randomized controlled trial

Víctor M. Peña-Martínez, Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
Aurelio Martínez-Lozano, Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
Adriana C. Guerrero-López, Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
Mario Simental-Mendía, Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
Carlos A. Acosta-Olivo, Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico

Background: Distal radius fractures are among the most common pediatric injuries. Although short-arm casts are widely used, uncertainty persists regarding whether short plaster or fiberglass provides better radiographic maintenance of reduction, functional recovery, and patient comfort. Objective: To compare radiological outcomes, wrist mobility, and patient satisfaction between short-arm plaster casts and short-arm fiberglass casts in children with displaced distal radial metaphyseal fractures. Methods: A randomized, single-blinded, controlled clinical trial was conducted in children aged 2-12 years with displaced distal radial metaphyseal fractures. Patients were randomized (1:1) to receive either a short-arm plaster cast or a short-arm fiberglass cast following closed reduction. Primary outcomes included initial and final angulation, shortening, and remodeling percentage. Follow-up evaluations were performed at 6 months. Results: Sixty-eight patients were randomized, and 64 (32 per group) completed follow-up. Baseline characteristics were similar between groups. No significant differences were found in radiographic outcomes, including final angulation (plaster 10.5° ± 2.3° vs. fiberglass 10.2° ± 2.1°, p = 0.78), final shortening (1.2 ± 0.4 mm vs. 1.1 ± 0.3 mm, p = 0.65), or remodeling percentage (92.3% ± 3.5% vs. 93.1% ± 3.2%, p = 0.68). Wrist mobility at 6 months and patient comfort scores showed no significant differences between groups. No complications or treatment failures occurred. Conclusion: Short-arm plaster and fiberglass casts provide comparable radiographic, functional, and comfort outcomes in the management of displaced pediatric distal radius fractures. Either material represents an effective immobilization option following closed reduction.

Keywords: Distal radius fracture. Plaster cast. Fiberglass cast. Closed reduction. Pediatric fractures.