Cumbersome casts cast off by modern medicine

Custom-molded splints
Advances in splints have revolutionized treatment of wrist fractures in the past few years, Fernandez said.

“Splints now are custom-molded to the body with thermoplastic material allowing a custom fit to immobilize and support without the constriction of the cast,” Fernandez said. “These are not the 'off-the-rack' splints you buy at the pharmacy,” he said. They’re “more like a custom-tailored suit.”

For some kids, though, casts are still cooler.

Sarah Bond, 11, a suburban Chicago fifth-grader, suffered the same kind of injury as Ben 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,” Bond 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 Naperville’s Edward Hospital.

Adjustable 'cast boots'
Dr. Stuart Hirsch, an orthopedic surgeon in Bridgewater, N.J., says he gets around that disappointment by offering kids a white sock-like device that fits over splints and can be written on with a felt-tipped pen, telling patients to have their friends sign that.

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’re 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.

And like splints, they’re adjustable. A drawback with casts is that as the confined limb loses muscle mass, the cast loosens and rubs, causing pain and often requiring doctors to replace it. Cast removal, generally with noisy, vibrating medical saws, can be frightening for children.

Adjustable devices can be tightened as needed, LaBella said.

Pins, plates and rods offer alternatives
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.

For some fractures, that means starting to use the injured limb within a few weeks rather than a few months of immobilization in a cast, he said.

These devices are most appropriate for adults, whose bone growth plates have closed, Jimenez said.

But pins and locked plates sometimes are used for school-age children with broken thigh bones who used to be treated with three weeks of traction and then a cast for a month or two, said Dr. John Flynn of The Children’s Hospital of Philadelphia. And he said they’re occasionally used for older children’s forearm or elbow fractures.

Patients and their parents have higher expectations these days and often won’t accept “anything short of perfect,” said Flynn. “They want a bone to be put back straight.”

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