Biobased polyester versus synthetic fiberglass casts for treating stable upper limb fractures in children: a randomized controlled trial

Abstract

Background: Stable upper limb fractures, such as radius, ulna, or distal humerus fractures, are common pediatric orthopedic traumas that are traditionally managed with cast immobilization. The commonly used synthetic fiberglass cast is light and water resistant but may promote skin itchiness during casting, which is a common complaint of patients. In addition, these diisocyanate-based casts have been proven to be toxic and may cause asthma. Herein, we introduce a novel biobased polyester cast to compare its clinical outcomes and patient satisfaction with conventional synthetic fiberglass casts.

Methods: From Feb 2022 to Nov 2022, we undertook a single-center prospective randomized trial involving 100 children with cast-immobilized stable upper limb fractures. These patients were randomized into either biobased polyester or synthetic fiberglass groups. All patients were regularly followed up till the cast removal which occurred approximately 3-4 weeks after immobilizing. Objective clinical findings and subjective patient questionnaire were all collected and analyzed.

Results: According to the radiographs taken on the day of cast removal, there was no loss of reduction in both groups. The incidence of skin problems was 3.4 times higher in the synthetic fiberglass group than in the biobased polyester group. For the subjective questionnaire, the biobased polyester cast was preferred in every sub-item.

Conclusions: Our study strongly suggested that the novel biobased polyester cast provides matching stability to conventional fiberglass casts and improves patient satisfaction in an eco-friendlier and safer way.

Trial registration: ClinicalTrials.gov Protocol Registration and Results System ( https://www.

Clinicaltrials: gov/ ; ID: NCT06102603; Date: 26/10/2023).

Keywords: Biobased polyester cast; Pediatric upper limb fracture; Synthetic fiberglass cast.

Fig. 1

Images of biobased polyester and fiberglass casts being worn by patients

Fig. 2

Flow diagram shows the progress of all patients through each stage

Fig. 3

Bar chart of mean patient satisfaction score in biobased polyester cast and fiberglass cast groups. The error bars denote standard error of the mean. The asterisks denote statistical significance (p < 0.05)

Fig. 4

(A) Synthesis of the poly(ethylene sebacate-co-ethylene adipate). copolyester. Abbreviations: SeA = sebacic acid, EG = ethylene glycol, AA = adipic acid, TMA = trimesic acid, and EACA = aminocaproic acid. (B) The schematic picture displays the composite of the novel biobased polyester cast

Fig. 5

A radiography image comparing transparency between the two groups. (A) Biobased polyester cast; (B) Fiberglass cast