Doctors cast off plaster in favor of high-tech options to fix bones

CHICAGO (AP) — The black Velcro bandage strapped on 3-year-old Ben Crotty’s left arm looks like a Rollerblader’s wrist guard, but it’s really a mini medical milestone.

It’s today’s answer to the cast.

Once almost a childhood rite of passage, plaster or fiberglass casts were the method of choice for fixing broken bones. But now, doctors around the world are increasingly shunning cumbersome casts in favor of more cutting-edge options for both children and adults: splints, special boots, metal plates, rods and screws.

For Ben’s broken wrist, it was a removable splint.

Support for the modern technique on children was bolstered by a Canadian study last month in the journal Pediatrics. It showed that in children ages 6 to 15 with wrist fractures like Ben’s, those who wore removable splints for three weeks had better physical function during treatment and afterward than those treated with plaster casts.

The splinted children also escaped cast-related problems: Four youngsters sought emergency room treatment for wet casts and one for removing a pencil placed under the cast.

As an emergency room doctor at Chicago’s Children’s Memorial Hospital, Steve Crotty, Ben’s dad, is all too familiar with some of casts’ nastier complications.

Casts that aren’t waterproof can get moldy, and Dr. Crotty said he’s “seen maggots crawling out of casts” that children got wet.

Sarah Bond, 11, a suburban Chicago fifth-grader, suffered a broken wrist during a recent basketball game and was offered a splint, but she chose a pink fiberglass cast instead.

“It’s fun to have a cast because your friends get to sign it,” Sarah said.

“The cool factor is much bigger in kids, and the look on their faces when you say they don’t need a cast is pretty bad,” said Dr. Matthew Bueche, a pediatrician at Edward Hospital in Naperville, Ill.

Dr. Stuart Hirsch, an orthopedic surgeon in Bridgewater, N.J., says he gets around that disappointment by offering children a white sock-like device that fits over splints and can be written on with a felt-tipped pen.

Other cast alternatives include “cast boots,” which look and feel like wearing ski boots and are used to treat some foot and ankle fractures. They are removable for bathing and easier to walk in than old-fashioned “walking casts,” said Dr. Cynthia LaBella, medical director at the Institute for Sports Medicine at Chicago’s Children’s Memorial Hospital.

In the past five years or so, better alloy metals and advances in design and technology have made use of pins, rods and special metal plates that “lock” onto bone fragments commonplace in treating adult fractures.

Some of those newer devices require surgery to implant them next to broken bones, but they’re far better than casts at realigning bones into a normal position, said Dr. Matthew Jimenez of the Illinois Bone and Joint Institute in Morton Grove.

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