~ 6 ~ International Journal of Orthopaedics Sciences 2018; 4(2): 06-10 ISSN: 2395-1958 IJOS 2018; 4(2): 06-10 © 2018 IJOS www.orthopaper.com Received: 02-02-2018 Accepted: 03-03-2018 Limbu A Assistant Professor, Department of Orthopaedics, BP Koirala Institute of Health Sciences, Dharan, Nepal Khanal GP Professor, Department of Orthopaedics, BP Koirala Institute of Health Sciences, Dharan, Nepal Chaudhary P Professor, Department of Orthopaedics, BP Koirala Institute of Health Sciences, Dharan, Nepal Maharjan R Additional Professor, Department of Orthopaedics, BP Koirala Institute of Health Sciences, Dharan, Nepal Correspondence Dr. Amit Limbu Assistant Professor, Department of Orthopaedics, BP Koirala Institute of Health Sciences, Dharan, Nepal A prospective RCT comparing the outcome of above- knee and below-knee pop cast application for isolated tibial shaft fractures in children Limbu A, Khanal GP, Chaudhary P and Maharjan R DOI: https://doi.org/10.22271/ortho.2018.v4.i2a.02 Abstract Purpose: Above-Knee Cast has been standard treatment for treating tibial fractures in children. We conducted this study to evaluate the time of union, complication and cost of treatment between above- Knee and Below-Knee Cast groups in children with isolated tibial shaft fractures. Study Design: Sixty children of age 6 months-15 years were randomized into Above-Knee and Below- Knee Cast group, who were followed and compared; till 6 months from January 2012 to March 2013. 10 children (6 torus, 2 undisplaced, 2 displaced fractures) lost to follow up at 6 months and were analyzed with missing value data analysis at 6 months. Results: All fracture united (8.30±2.69 weeks in Above-Knee Cast, 7.70±2.54 weeks in Below-Knee Cast). The pre-reduction parameters were varus (2-8 o ), valgus (4-8 o ), anterior angulation (4-9 o ), Posterior angulation (2-10 o ), Internal Rotation (3-6 o ), External rotation (3-6 o ), shortening (6.46 mm). At 6 months, above parameters were 2.83 o ±0.85, 3.20 o ±0.44, 2.83 o ±1.32, 2.67 o ±0.84, 3.40 o ±0.54, 2.83 o ±0.75, 2.67±1.15mm respectively in Above-Knee group and 2.60 o ±0.84, 2.50 o ±0.52, 3.00 o ±1.00, 2.93 o ±1.32, 3.00 o ±1.41, 2.33 o ±0.57, 2.00±0.00mm respectively in Below-Knee group. Reinforcement requirement of plaster was higher in Below-Knee cast (p=0.014). There were no refractures, residual complications. Conclusions and clinical relevance: Below-Knee cast is as effective as Above-Knee Cast for treatment of Isolated tibial shaft fractures in child with superior ROM at knee and low cost (p<0.000). Keywords: Isolated, tibia, below-knee Introduction Tibial and fibular fractures are the third most pediatric most common pediatric long bone fractures (15%); after radial/ulnar and femoral fractures. (Shannak, 1988) [11] About 70% of pediatric tibial fractures are isolated injuries. Fifty to seventy percent occurring in distal third and nineteen to thirty-nine in the middle third. (Bennek & Steinert, 1966 [2] ; Yang & Letts, 1997) [17] Most tibial fractures in children are closed injuries and traditionally managed conservatively with above-knee cast whether isolated or associated with ipsilateral fibular fracture. The standard treatment for the majority of closed tibial-shaft fractures consists of closed reduction and cast immobilization. (Bostman, 1986; Nicholl, 1964; Sarmiento et al. 1984; Watson-Jones & Coltart, 1982) [3, 8, [10, 16] . Contradicting statements can be found with the influence of intact fibula with hastening or delaying union and may complicate to angulate into varus position. (Klatt JWB, Stotts AK, & Smith, 2010; Nicholl, 1964; O'Dwyer, DeVriese, Feys, & Vercruysse, 1993; Yang & Letts, 1997) [7, 8, 9, 17] . Although immobilizing one joint below and one joint above is widely practiced and accepted, recent retrospective study has shown equally effective result of below-knee cast in isolated tibial shaft fractures in children and we evaluated prospectively to compare the effect between the Above-Knee Cast and Below-Knee cast. (Klatt JWB et al. 2010; Yang & Letts, 1997) [7, 17] Materials and Methods Total 60 children from age 6 months to 15 years with isolated fracture of middle and distal third tibia were included in this study who attended our institute from January 2012 to March 2013. Exclusion criteria were proximal tibial fractures, comminutes greater than Winquist and Hansen Grade I, segmental fracture, open fractures above Gustilo Grade II, intra-articular