Children's daily living activities during immobilization of upper-limb fractures with an above- or below-elbow cast

Background: The purpose of this prospective study was to assess the impact of cast immobilization on the activities of daily living in children with fractured upper limbs. Methods: Using the Activities Scale for Kids (ASK), 52 consecutive children (17 girls, 35 boys), aged 5-15 years (mean, 9 years), with upper limb fractures treated by means of above- or below-elbow casts were assessed. The files were reviewed for background and fracture-related data. Results: Mean score of the above-elbow group was 65.4 ± 15.5 points on the ASK capability domain (ASK-c) (with cast) and 98.7 ± 3 points on the ASK-performance domain (without cast). Corresponding scores for the below-cast group were 89.8 ± 13 and 99.5 ± 2. Factors that positively affected overall function were older age, male sex, shorter duration of pain, and less displacement. On multivariate analysis, only age proved to be a potential predictive factor. Cast position and hand dominance had no effect. The specific activities affected were personal hygiene, dressing, making a snack, and reaching high objects. Conclusions: To ease their children's adjustment to forearm cast immobilization after fractures, parents should be educated in the areas of daily living that may be affected. This is particularly true for younger children with more displaced fractures that cause more pain.