CAM Boot or Cast for Toddler’s Fracture?

August 11, 2021

Written by Clay Smith

Spoon Feed
Children with a toddler’s fracture who were randomized to a CAM boot were easier to care for, walked sooner, and had no difference in fracture healing compared to those in a cast.

Why does this matter?
We have discussed using a CAM (controlled ankle motion) walker boot or cast for toddler’s fractures before, but the quality of the data was low. The prior systematic review had 5 retrospective studies and one survey study. Here is some much higher quality data to help us manage these kids.

These boots are made for walkin’
This was a RCT with 87 patients age 1-5, median 2, who were randomized to a CAM boot or plaster of Paris cast. For the primary outcome of ease of personal care, the CAM boot group was much better than the cast group. They used a validated score which measured the parental score for ease of dressing, bathing, diaper changing, etc.; essentially ease of activities of daily (toddler) living. The boot group also was able to bear weight much sooner. Both had no difference in fracture healing or pressure sores. About 1/3 in each group reported some pressure areas, all stage 1. Two were changed from boot to cast. One had displacement on follow up not noticed at first that should have precluded use of a boot. The other fell, had pain, had no change in fracture alignment, but was changed to a cast. Bottom line: Go with the boot.

Source
Randomised controlled trial comparing immobilisation in above-knee plaster of Paris to controlled ankle motion boots in undisplaced paediatric spiral tibial fractures. Emerg Med J. 2021 Jun 22;emermed-2020-210299. doi: 10.1136/emermed-2020-210299. Online ahead of print.