Letters to the Editor
Correspondence Tried and Tested Option in Children
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The analysis on immobilization in a Schede cast (1) triggered a lively but fact-focused internal discussion in the German Society for Surgery of the Hand (Deutsche Gesellschaft für Handchirurgie, DGH). The photo accompanying the publication of a seemingly “extreme” angle of flexion of the cast was considered with some skepticism; in reality in clinical practice, the positioning of the wrist as a result of padding and positioning usually seems less pronounced, which is reflected in the reproduced x-ray film. While the Schede position in adults is obsolete, the available data confirm that it can be used safely in children: in the study under discussion, a secondary displacement was observed in 2.9% of cases and paresthesias in 2.2% of cases, with neither resulting in permanent injury. In sufficient flexion (about 45–60%) and a brief period of immobilization (3–4 weeks), surgery can thus often be avoided. Spontaneous correction (up to 4°/month in younger children) in the course of further growth allows for greater tolerance ranges than in adults. We would welcome further multicenter studies, but until those are carried out, Schede retention is a tried and tested, child-appropriate, and resource-sparing option. The prerequisites are experience with its use and structured clinical follow-ups.
DOI: 10.3238/arztebl.m2025.0177
Dr. med. Frank Eichenauer
Repräsentant der Deutschen Gesellschaft für Handchirurgie (DGH)
Mitglied im Gesamtvorstand der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie e V. (DGOU), Berlin
office@dgou.de
Prof. Dr. med. Dietmar Pennig, Prof. Dr. med. Bernd Kladny
Generalsekretäre der Deutsche Gesellschaft für Orthopädie und Unfallchirurgie e V. (DGOU), Berlin
Conflict of interest statement
The authors declare that no conflict of interest exists.
The authors of the article declined the opportunity to respond.
| 1. | Wintges K, Schultz J, Rausch T, et al.: Immobilization in a schede cast as a treatment option for distal forearm fractures in children and adolescents: Findings on efficacy and safety. Dtsch Arztebl Int 2025; 122: 360–1 VOLLTEXT CrossRef MEDLINE PubMed Central |
