Waterproof casts for the management of upper limb fractures in children: a systematic review and meta-analysis

Badhe, Neel; Busby, Christopher; See, Abbas; Deacon, Christopher; Altell, Tareq; Ollivere, Ben J.; Marson, Ben A.

Abstract

Aims
Upper limb fractures in children are often managed in casts. Waterproof casts which allow safe immersion in water may be used. These may improve comfort, convenience, and satisfaction when compared with standard casts. The aim of this review was to compare the efficacy, safety, and satisfaction of waterproof casts with standard casts in the management of upper limb fractures in children.

Methods
A systematic review of randomized controlled trials (RCTs) was conducted in September 2024. Comprehensive searches of Medline, PubMed, Cochrane CENTRAL, and EMBASE databases were performed. Studies were included which recruited children aged 0 to 18 years with upper limb fractures, which were managed in waterproof or standard casts. Patient-reported outcomes, functional outcomes, and complication rates were assessed.

Results
A total of five studies involving 390 children were included. Those managed with a waterproof cast reported significantly superior satisfaction with regard to comfort (mean difference (MD) 1.92 (95% CI 0.15 to 3.69); p = 0.034), itchiness (MD 0.21 (95% CI 0.00 to 0.43); p = 0.047), and overall child and parent satisfaction (MD 0.53 (95% CI 0.01 to 1.05); p = 0.048). Those managed with a waterproof cast also had significantly improved functional outcomes as measured by the Activities Scale for Kids-Performance (ASK-P) score, with a MD of 16.90 (95% CI 6.87 to 26.93; p = 0.001). There were no significant differences regarding heat or sweatiness, pain, return to recreational activities, unexpected returns for cast maintenance, radiological deformity, or skin problems.

Conclusion
Waterproof casts seem to provide an alternative to standard casts in the management of upper limb fractures in children. There were improved functional outcomes at the time of removal of the cast, improved comfort, and less itching. Pooling of the studies was limited due to the heterogeneity of the reporting of outcomes and the small sizes of the studies. Neither long-term outcomes, nor economic analysis based on healthcare-related quality of life, are available. A definitive RCT based on a core outcome set is required to confirm the efficacy and investigate the cost-effectiveness of waterproof casts in children.

Citation

Badhe, N., Busby, C., See, A., Deacon, C., Altell, T., Ollivere, B. J., & Marson, B. A. (2025). Waterproof casts for the management of upper limb fractures in children: a systematic review and meta-analysis. The Bone & Joint Journal, 107-B(6), 587-594. https://doi.org/10.1302/0301-620x.107b6.bjj-2025-0011

• Journal Article Type: Article
• Acceptance Date: Feb 24, 2025
• Online Publication Date: Jun 1, 2025
• Publication Date: 2025-06
• Deposit Date: Jul 2, 2025
• Publicly Available Date: Jul 4, 2025
• Journal: The Bone & Joint Journal
• Print ISSN: 2049-4394
• Electronic ISSN: 2049-4408
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 107-B
• Issue: 6
• Pages: 587-594
• DOI: https://doi.org/10.1302/0301-620x.107b6.bjj-2025-0011
• Public URL: https://nottingham-repository.worktribe.com/output/51020327
• Publisher URL: https://boneandjoint.org.uk/Article/10.1302/0301-620X.107B6.BJJ-2025-0011