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Best position of immobilisation in a greenstick fracture of the distal radius

Three Part Question

in [a child aged 3-12] with [a greenstick fracture of the distal radius] should [the forearm be immobilised in the pronated, neutral or supinated position]

Clinical Scenario

an eight year old child presents to the emergency department with a suspected wrist fracture. radiology confirms a greenstick fracture of the distal radius. treatment is with the application of a plaster of Paris cast, but in which position should the forearm be immobilised (pronated, neutral or supinated)

Search Strategy

Medline 1966- June 2005
CINAHL 1982- June 2005
The cochrane library, issue 2, 2005

Search Outcome

1 citation which was a high quality randomised control trial

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Gupta RP
Feb 1990
60 children, 20 randomly allocated to each groupprospective randomised control trialre-displacement after immobilisationangular displacement greatest in pronation group and least in the supination group


fracure of the distal radius is a common injury in children. treatment is with the application of a plaster of Paris cast. this review has found that angular displacement after the application of a cast occurs less often when the forearm is immobilised in the supinated position.

Clinical Bottom Line

forearm should be immobilsed in the supinated position


  1. Gupta RP Dorsally angulated solitary metaphyseal greenstick fractures in the distal radius: results after immobilisation in pronated, neutral and supinated position