To Compare the Outcome of Diaphyseal Fracture Both Bones Forearm in Children Treated with Above Elbow Cast for 6 Weeks Versus 3 Weeks Followed by Below Elbow Cast for Another 3 Weeks

ackground: Diaphyseal fractures of both bones of the forearm are among the most common pediatric injuries encountered in orthopedic practice. Conservative management using cast immobilization remains the mainstay of treatment in children due to their excellent remodeling potential. However, the optimal duration and type of casting required to achieve satisfactory functional and radiological outcomes remains a subject of debate. Traditionally, above elbow cast immobilization for six weeks has been widely practiced, though prolonged elbow immobilization may lead to stiffness and delayed functional recovery. An alternative strategy involves initial above elbow casting followed by conversion to a below elbow cast, aiming to balance fracture stability with early joint mobilization. Aim: To compare the clinical, radiological, and functional outcomes of diaphyseal fractures of both bones of the forearm in children treated with above elbow cast immobilization for six weeks versus those treated with above elbow cast for three weeks followed by below elbow cast for another three weeks. Methods: This prospective comparative study was conducted in the Department of Orthopaedics, Government Medical College, Kathua. Children aged 5–14 years presenting with closed diaphyseal fractures of both bones of the forearm were enrolled and divided into two groups. Group A was treated with above elbow cast immobilization for six weeks, while Group B received above elbow cast for three weeks followed by below elbow cast for another three weeks. Patients were followed at regular intervals for clinical assessment, radiological union, range of motion at elbow and forearm, time to functional recovery, and complications. Functional outcomes were evaluated using standardized assessment criteria. Results: A total of 60 children were included in the study, with 30 patients in each group. Radiological union was achieved in 28 patients (93.3%) in Group A and 29 patients (96.7%) in Group B, with a mean union time of 7.8 ± 1.2 weeks and 7.4 ± 1.0 weeks respectively. At final follow-up, full or near-full elbow range of motion was observed in 21 patients (70%) in Group A compared to 26 patients (86.7%) in Group B. Restriction of forearm rotation exceeding 20 degrees was noted in 6 patients (20%) in Group A and 2 patients (6.7%) in Group B. Complications such as elbow stiffness were more common in Group A (8 patients, 26.7%) compared to Group B (3 patients, 10%). No significant difference was observed between the groups with respect to loss of reduction or malunion. Conclusion: Conversion from above elbow cast to below elbow cast after three weeks provides outcomes comparable to six weeks of above elbow immobilization while offering the advantage of improved joint mobility and earlier functional recovery. This method represents an effective and patient-friendly alternative in the conservative management of pediatricdiaphyseal forearm fractures.