Quantifying the amount of padding improves the comfort and function of a fibreglass below-elbow cast M. Monument a , G. Fick b , R. Buckley a, * a Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada b Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Introduction Casting is the most common immobilisation technique used in the management of acute fractures of the distal forearm. The purpose of modern casting is to prevent displacement of the fracture, encouraging callus formation and fracture healing. 22 Despite the great number of below-elbow casts applied to forearms every year, few clinical studies have addressed the issues of patient comfort and functionality during fracture immobilisation using a fibreglass cast. Studies have examined different types of casting materials such as fibreglass, plaster-of- Paris and polyester, 4,5,12 and alternative liners such antibiotic- impregnated 15 and waterproof materials. 9,19–21 Other workers have explored different casting techniques such as removable splints 16,18 and focused rigidity casting. 3 Despite this evidence, current practice in North America is usually to use fibreglass casting material in the closed treatment of fractures of the upper extremity, largely because of its superior strength, resistance to delamination, lower weight, radiolucency and improved resistance to water exposure. 1,2,10,11 To our knowledge, there has been little clinical investigation of patient comfort. Current recommendations favour a below-elbow fibreglass cast constructed of a dressing of stockinet and 2–5 layers of cotton underpadding, followed by 2–3 layers of well-moulded fibreglass tape. 6,8,17,22,23 Within these guidelines there is a considerable room for variation, in particular regarding the quantity of cotton underpadding required for patient satisfac- tion and comfort, while maintaining functionality. Common recipient complaints during cast immobilisation pertain to wetness, odour, itchiness beneath the cast and pressure over bony prominences. 10,13–15,17 Together these features contribute to overall discomfort, but can largely be modified by varying the quantity of cotton underpadding. In view of the shortage of clinical information on this subject, this study was undertaken to determine the quantity of cotton underpadding required to make a comfortable, functional, below- elbow fibreglass cast. Injury, Int. J. Care Injured 40 (2009) 257–261 ARTICLE INFO Article history: Accepted 30 June 2008 Keywords: Fibreglass cast Distal radius Fracture Patient comfort ABSTRACT Aim: To determine the quantity of cotton underpadding needed for a comfortable, functional, below- elbow fibreglass cast. Methods: In this randomised, prospective, crossover, clinical trial, 45 people with minimally displaced distal radial fractures were enrolled to randomly receive, 14 days after injury, a fibreglass below-elbow cast with either two or four layers of cotton underpadding. The characteristics of the recipients were recorded. After 2 weeks of immobilisation, participants completed a numerical survey evaluating parameters of comfort and underwent clinical and radiographic assessment. They then crossed over to receive the other fibreglass cast design, the process was repeated, and they indicated their cast preference, if any. Results: Of 37 people who completed the study, 20 preferred the two-layer model, 13 the four-layer model and 4 had no preference. No significant trend for one design over the other was shown (p = 0.1), nor any statistical association between preference and participant characteristics or the order in which cast models were received. Conclusions: Participants did state a preference, but this was not related to recipient characteristics. Neither cast design was significantly the more comfortable; and both models were safe and functionally satisfactory. ß 2008 Elsevier Ltd. All rights reserved. * Corresponding author at: Foothills Medical Centre, AC 144A, 1403 – 29th Street N.W., Calgary, Alberta T2N 2T9, Canada. Tel.: +1 403 944 8371. E-mail address: buckclin@ucalgary.ca (R. Buckley). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter ß 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2008.06.035