***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction A prospect i ve pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China . Methods The sample consisted of 202 consecutive children ( mean age 7 years ; range 3–12 years ) with closed forearm fractures treated nonoperatively . Children with open , growth-plate fractures or fractures associated with dislocation of the nearby joint ( i.e. , monteggia fractures ) were excluded . In 28 children who had torus fractures , radiographic examination was performed at the time of cast removal , 3 weeks after the start of treatment . In 63 children who had stable fractures that did not require reduction ( undisplaced or minimally displaced , complete or greenstick ) , radiographic examination was performed 1 week after the start of treatment and again at cast removal 4–6 weeks later . In the remaining 111 children with complete , displaced , or greenstick fractures ( all with angulation of more than 15 ° ) who underwent closed reduction , an additional X-ray was taken 2 weeks after cast placement . All children ( except those with torus fractures ) were followed clinical ly , without further radiographic examination , for 3 months after cast removal . Results Radiographs at cast removal showed good union in all stable fractures , indicating that additional X-rays on cast removal would have had no added value . In the children with unstable fractures , only 9 showed redisplacement with angulation of more than 15 ° on repeated X-rays during the first 2 weeks after cast placement . All 9 underwent successful re-reduction . On clinical evaluation 3 months after cast removal , all patients in the sample had full range of elbow and forearm motion . Repeated fracture did not occur in any of the patients . Conclusions On the basis of these results , radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures . At the time of cast removal , if clinical examination does not show signs of nonunion or malalignment , no radiographic examination is necessary In a prospect i ve study , we r and omly allocated 39 patients with isolated fractures of the lower two-thirds of the ulnar shaft to treatment either by a  prefabricated functional brace or a long-arm cast . Significantly better wrist function and a higher percentage of satisfied patients were found in the braced group . Thirteen patients returned to employment while still wearing the brace but only one was able to work in a cast BACKGROUND Greenstick fractures suffered during growth have a high risk for refracture and posttraumatic deformity , particularly at the forearm diaphysis . The use of a preemptive completion of the fracture by manipulation of the concave cortex is controversial and data supporting this approach are few . AIM Aim of this study was to determine the factors which predispose to refracture and deformities , and to define therapeutic strategies . METHODS We prospect ively gathered clinical and radiographic data over a period of one year on  greenstick fractures of the middle third of the forearm in children as part of a multi-centre study . Endpoint was a follow-up visit at one year . Radiographic deformity , state of consolidation at resumption of physical activities and refracture rate were analysed statistically ( ANOVA , Student 's t-test and Pearson 's chi-square test ) with regard to patient age , gender , fracture type , therapy and time in plaster . RESULTS We collected the data of 103 patients ( 63 boys , 40 girls ) , average age 6.6 years ( 1.3 - 14.5 years ) , the vast majority of whom had a combined greenstick fracture of the radius and ulna . 6.7 % of the patients sustained a refracture within 49 days ( 29 - 76 ) after plaster removal . They were significantly older ( p=0.017 ) with a significantly higher incidence of manual completion of the fracture with radiographic signs of partial consolidation ( p=0.025 ) . Residual deformities were significantly smaller after completion of the fracture compared to reduction without completion ( p=0.019 ) or plaster fixation alone ( p<0.005 ) . CONCLUSIONS Completion of a greenstick fracture does not prevent refracture . Nevertheless , it diminishes the extent of secondary deformities in cases where the primary angulation exceeds the remodelling capacity . Prevention of refracture should include a routine radiographic follow-up 4 - 6 weeks after injury with continuation of plaster fixation in cases of partial consolidation The purpose of this study was to evaluate the effect of forearm position on residual fracture angulation for pediatric distal-third forearm fractures at the time of union . One hundred nine pediatric distal-third forearm fractures undergoing closed reduction and casting  were prospect ively r and omized to be immobilized in pronated , supinated , or neutral position . Initial angulation and displacements were radiographically compared with healed fracture angulation at a minimum of 6 weeks . With 99 complete patient files , 38 fractures were casted in neutral , 26 in pronated , and 35 in supinated positions . Average initial angulation was 20 ° ; postreduction angulation measured 3 ° . Final angulation at union averaged 7 ° for all fractures . Forearm position failed to show a significant effect on fracture angulation at union . Residual fracture angulation at the time of union for pediatric distal-third forearm fractures was not significantly affected by forearm position ( pronation , supination , neutral ) during cast immobilization Background : The Accreditation Council on Graduate Medical Education-m and ated 80-hour work week has led many teaching hospitals to find adequate replacements for residents . In addition , the subspecialty of pediatric orthopaedics is currently experiencing a workforce shortage . At the authors ' institution , Level I emergency department and hospital on-call duties alternate between orthopaedic residents and orthopaedic-specific nurse practitioners . There are no studies looking at the quality of care rendered in the pediatric orthopaedic setting by physician extenders . Methods : A consecutive series of 139 pediatric patients with the diagnosis of closed both-bones diaphyseal forearm fracture underwent closed reduction and casting by either a trained nurse practitioner or orthopaedic resident in the emergency department from July 2006 through June 2007 . Fifty-seven ( 41 % ) patients were treated by a nurse practitioner and 82 ( 59 % ) patients were treated by an orthopaedic resident . All patients were followed to completion of treatment by fellowship-trained pediatric orthopaedic staff . Results : There was no significant difference between the two groups in regard to the use of conscious sedation , cast characteristics , fracture characteristics , or length of follow up ( P > 0.05 ) . Patients treated by orthopaedic residents required more minor interventions ( 48 % versus 35 % ) , but this was not statistically significant ( P = 0.17 ) . However , patients treated by orthopaedic residents had a higher rate of requiring premedication and molding of a new cast in clinic for loss of reduction ( 33 % versus 18 % ) , and this did approach statistical significance ( P = 0.052 ) . In addition , patients treated by orthopaedic residents had slightly more major interventions , which necessitated operative intervention to restore alignment of the fracture ( 11 % versus 8 % ) , but this did not reach statistical significance ( P = 0.56 ) . Conclusions : Pediatric patients with closed both-bones diaphyseal forearm fractures were treated successfully by both trained orthopaedic nurse practitioners and orthopaedic residents with no statistically significant difference in interventions Redisplacement of unstable forearm fractures in plaster is common and may be the result of a number of factors . Little attention has been paid to the influence of immobilisation with the elbow extended versus flexed . We prospect ively treated 111 consecutive children from two centres with closed forearm fractures by closed reduction and casting with the elbow either extended ( 60 ) in China or flexed ( 51 ) in Israel . We compared the outcome of the two groups . There was no statistically significant difference in the distribution of the age of the patients , the site of fracture or the amount of angulation and displacement between the groups . During the first two weeks after reduction , redisplacement occurred in no child immobilised with the elbow extended and nine of 51 children ( 17.6 % ) immobilised with the elbow flexed . Immobilisation of unstable forearm fractures with the elbow extended appears to be a safe and effective method of maintaining reduction A number of new synthetic orthopaedic splinting material s , all cl aim ing substantial advantages over the traditional plaster-of-Paris , have been introduced in recent years . However , although their properties have been extensively measured in the laboratory , little has been documented concerning their performance in clinical use . This study was therefore initiated as a comparative evaluation of the clinical characteristics and ease of use of these relatively expensive material s in the fabrication of below-knee weight-bearing casts . The study encompassed nine material s -- seven based on water-activated polyurethanes , one thermoplastic and plaster-of-Paris , and involved a total of 203 patients . It was concluded that plaster-of-Paris should be used for all routine splinting applications , but that in cases in which cast weight , cast bulk , or the time to bearing weight is important , a synthetic material , chosen principally on the basis of cost , is indicated BACKGROUND Various methods of cast immobilization have been recommended for the treatment of distal forearm fractures in children . The purpose of this study was to determine if short arm casts are as effective as long arm casts in the treatment of displaced fractures of the distal third of the forearm in these patients . METHODS In a prospect i ve r and omized trial , consecutive patients , four years of age or older , who presented to The Women 's and Children 's Hospital of Buffalo with a displaced fracture of the distal third of the forearm were r and omized to treatment with a short or long arm plaster cast .  Radiographs were analyzed for displacement , angulation , and deviation at the time of injury , after reduction , and at subsequent follow-up intervals . The cast index at the fracture level , used to assess the quality of the cast molding , was determined from the postreduction radiographs . Changes between postreduction and final values for displacement , angulation , and deviation ; the ranges of motion of both wrists and elbows ; the need for physical therapy ; and responses to a question naire used to evaluate the effects of the cast on activities of daily living were compared between the groups . RESULTS One hundred and thirteen of the 151 patients who were assessed for eligibility were analyzed . The follow-up rate was 92 % , and the average duration of follow-up was eight months . Sixty long arm casts and fifty-three short arm casts were used . There were no significant differences between the two groups with regard to patient demographics , initial fracture characteristics , mechanism of injury , cast index , or the change in displacement , angulation , or deviation during treatment . The fractures that lost reduction in the cast had significantly higher cast indices , indicating poor cast-molding . A comparison of partially and completely displaced fractures revealed no difference between the groups with regard to the change between the postreduction and final amount of displacement . Patients treated with a short arm cast  missed fewer school days and were less likely to require assistance with various activities of daily living . CONCLUSIONS A well-molded short arm cast can be used as effectively as a long arm cast to treat fractures of the distal third of the forearm in children four years of age and older , and they interfere less with daily activities BACKGROUND Closed fractures of the distal third of the forearm are the most common fractures of childhood , but the method of immobilization after closed reduction is controversial . This study was undertaken to determine whether below-the-elbow casts are as effective as above-the-elbow casts in immobilizing these types of fractures and to identify patient and treatment considerations that are related to loss of reduction . METHODS We design ed a blinded , r and omized , controlled trial . The criteria for reduction and remanipulation were set a priori . The primary outcome measure was fracture immobilization as reflected by reangulation in the cast and by the need for remanipulation . Exploratory analysis with use of stepwise logistic regression analysis was undertaken to search for factors predictive of loss of reduction . RESULTS A total of 102 children were enrolled in the study and were allocated to two groups : the  above-the-elbow cast group ( fifty-six children ) and the  below-the-elbow cast group ( forty-six children ) . The mean age was 8.6 years , and sixty-one patients were boys . The groups did not differ with respect to the initial fracture angulation , postreduction angulation , reangulation during cast immobilization , and angulation of the fracture at the time of cast removal . In the above-the-elbow cast group , twenty-three ( 42 % ) of fifty-five children with adequate radiographs met the criteria for remanipulation compared with fourteen ( 31 % ) of forty-five children with adequate radiographs in the below-the-elbow cast group ( p = 0.27 ) ; only four of these thirty-seven children actually underwent remanipulation . Children with fractures of both the radius and ulna ( p = 0.01 ) and those with residual angulation after reduction ( p = 0.0001 ) were at the highest risk of meeting the criteria for remanipulation . The rates of complications related to the cast did not differ between the groups . CONCLUSIONS Below-the-elbow casts perform as well as above-the-elbow casts in maintaining reduction of fractures in the distal third of the forearm in children , and the complication rates are similar . Factors that are associated with a higher risk of loss of reduction include combined radial and ulnar fractures and residual angulation of the fracture after 
    Output:
    
This review found no usable evidence from r and omised trials to make recommendations concerning different conservative interventions for the treatment of diaphyseal fractures of the forearm bones in children .