INTRAOPERATIVE WEDGING OF CASTS - CORRECTION OF RESIDUAL ANGULATION AFTER MANIPULATION

Seventy children, aged 2-14 years, had a manipulation under anaestheti c (MUA) of a forearm or lower leg fracture, in which the MUA failed to fully correct the deformity in 16. An opening wedge (WEDGE) was perfo rmed while still under the original anaesthetic in one group and compa red to a parallel but uncontrolled group using the traditional regimen of remanipulation (RE-MUA). There was an observed reduction in the av erage time under anaesthetic comparing WEDGE to RE-MUA in the forearms (34 vs. 46 min) and in the legs (42 vs. 61 min). There was no obvious difference between the proportion of those needing ''further adjustme nts'' (defined as wedging at outpatients or a further MUA) if the frac ture displaced comparing WEDGING (zero of six) to RE-MUA (one of 10), and there was also no obvious increased time to union. At review, ther e was <10 degrees mal-union in any plane, which should not predispose to restricted forearm rotation or chronic ligamentous strain/joint deg eneration in the leg.