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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04642807
Registration number
NCT04642807
Ethics application status
Date submitted
18/11/2020
Date registered
24/11/2020
Titles & IDs
Public title
Management of Type 1 Supracondylar Humeral Fractures
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Scientific title
Management of Type 1 Supracondylar Humeral Fractures: A Multicentre Randomized Control Trial
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Secondary ID [1]
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H20-02942
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Elbow Fracture
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Trauma
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Condition category
Condition code
Injuries and Accidents
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Fractures
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Musculoskeletal
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Surgery - Long arm soft cast
Treatment: Surgery - Long arm full cast
Active comparator: Group 1 "Long-arm full cast and routine follow-up" - Patients assigned to Group 1 will be placed in a long arm cast, at 90-100 degrees in neutral rotation. A referral will then be made to the orthopedic department and the patient reviewed at week 3 with cast removal, clinical assessment and radiographic assessment as determined by the normal practice at the local center.
Experimental: Group 2 "Long-arm soft cast and no clinical or radiographic follow-up" - Patients assigned to group 2 will be placed in a long arm cast at 90-100 degrees in neutral rotation. They will be given verbal and written information on the injury, when and how to remove the cast and contact details if there are any concerns.
Since they will not be attending clinical follow-up, an email or telephone survey will be undertaken at 3 weeks and after 6 months. The survey will inquire initially about pain, unplanned returns to the Family Physician and hospital, complications, parent/patient satisfaction and a standardized patient reported outcome score will be taken. Please see attached documentation for the itemized survey questions. The 6 month follow-up will include photographs and an illustrated guide will be given to the families on how to obtain pictures of maximal flexion, extension and the child's carrying angle (attached). Measurements of range of motion from photographs are considered comparable to clinical assessment of range of motion
Treatment: Surgery: Long arm soft cast
Participants in group 2 will have a long arm soft cast applied without clinical or radiological follow up.
Treatment: Surgery: Long arm full cast
Participants in group 1 will have a long arm full cast applied.
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Intervention code [1]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Faces Pain Scale - Revised (FPS-R)
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Assessment method [1]
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The Faces Pain Scale - Revised (FPS-R) will be used to measure pain score. The scale uses a 0 to 10 metric that is in close linear relationship with a visual analogue pain scale. 0 is no pain and 10 is very much pain.
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Timepoint [1]
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3 weeks post fracture
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Secondary outcome [1]
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Number of unplanned visits to the hospital or family physician
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Assessment method [1]
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Any visits to the hospital or family physician that were not planned
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Timepoint [1]
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During cast treatment
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Secondary outcome [2]
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Is parental satisfaction higher when they are empowered to remove a splint at home and follow a physician directed treatment program?
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Assessment method [2]
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Timepoint [2]
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3 Weeks post fracture
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Secondary outcome [3]
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Is there a difference in range of elbow joint motion between the two groups at 6 months post fracture?
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Assessment method [3]
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Timepoint [3]
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6 months post fracture
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Secondary outcome [4]
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• Is the difference in carrying angle from the contralateral arm at 6 months post fracture similar in children undergoing no clinical follow up or radiographic follow up compared to children undergoing routine follow-up as per the standard of care?
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Assessment method [4]
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Timepoint [4]
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6 months post fracture
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Eligibility
Key inclusion criteria
- Children 3 to 8 years of age with a diagnosed supracondylar humerus fracture Type 1 (undisplaced).
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Minimum age
3
Years
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Maximum age
8
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
* Children diagnosed with a Type II or III supracondylar fracture or any other elbow injury
* Children who present with neurovascular compromise associated with their fracture
* Children who have been previously diagnosed with a metabolic or structural bone disease that predisposes them to fractures
Diagnostic criteria for a Type I supracondylar fracture will include either:
A) A clear fracture line through the supracondylar region with no displacement or angulation of the distal humerus (including a normal anterior humeral line that intersects the capitellum) OR B) The absence of a clear fracture line but history of an extension injury to the arm AND tenderness at the elbow AND local swelling AND presence of a posterior fat pad on plain radiographs.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/04/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/06/2024
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Actual
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Sample size
Target
52
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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Queensland Children's Hospital, 501 Stanley Street, - South Brisbane
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Recruitment postcode(s) [1]
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QLD 4101 - South Brisbane
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Recruitment outside Australia
Country [1]
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Canada
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State/province [1]
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British Columbia
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of British Columbia
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Address
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Other collaborator category [1]
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Other
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Name [1]
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Queensland Children's Hospital, South Brisbane
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
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Summary
Brief summary
This study compares the clinical outcomes of treating pediatric Type 1 supracondylar fracture with a long arm soft cast and no clinical or radiographic follow-up versus the standard treatment in a long arm cast with clinical follow-up. This is the first multicenter randomized control trial looking at the clinical effectiveness, safety and parental satisfaction of managing inherently stable Type I supracondylar fractures without clinical or radiological follow-up. If found to be safe; children can be managed effectively without in-person follow-up, freeing clinic appointments to children on the waiting list and in these COVID times avoiding unnecessary contacts.
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Trial website
https://clinicaltrials.gov/study/NCT04642807
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Trial related presentations / publications
Silva M, Sadlik G, Avoian T, Ebramzadeh E. A Removable Long-arm Soft Cast to Treat Nondisplaced Pediatric Elbow Fractures: A Randomized, Controlled Trial. J Pediatr Orthop. 2018 Apr;38(4):223-229. doi: 10.1097/BPO.0000000000000802. Witney-Lagen C, Smith C, Walsh G. Soft cast versus rigid cast for treatment of distal radius buckle fractures in children. Injury. 2013 Apr;44(4):508-13. doi: 10.1016/j.injury.2012.11.018. Epub 2012 Dec 22. Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am. 2008 Apr;39(2):163-71, v. doi: 10.1016/j.ocl.2007.12.005. Beaty JH and Kasser JR. The Elbow Region: General Concepts in the Pediatric Patient. In: Beaty JH and Kasser JR (editors). 6th ed. Philadelphia: Lippincott, Williams & Wilkins; 2006. Wilkins KE and Rockwood CA. Fractures and Dislocations of the Elbow Region. 4th ed. Philadelphia: Lippincott-Raven; 1996. GARTLAND JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959 Aug;109(2):145-54. No abstract available. Barton KL, Kaminsky CK, Green DW, Shean CJ, Kautz SM, Skaggs DL. Reliability of a modified Gartland classification of supracondylar humerus fractures. J Pediatr Orthop. 2001 Jan-Feb;21(1):27-30. doi: 10.1097/00004694-200101000-00007. Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am. 1999 Oct;81(10):1429-33. doi: 10.2106/00004623-199910000-00007. Symons S, Rowsell M, Bhowal B, Dias JJ. Hospital versus home management of children with buckle fractures of the distal radius. A prospective, randomised trial. J Bone Joint Surg Br. 2001 May;83(4):556-60. doi: 10.1302/0301-620x.83b4.11211. Meislin MA, Wagner ER, Shin AY. A Comparison of Elbow Range of Motion Measurements: Smartphone-Based Digital Photography Versus Goniometric Measurements. J Hand Surg Am. 2016 Apr;41(4):510-515.e1. doi: 10.1016/j.jhsa.2016.01.006. Epub 2016 Feb 13. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain. 2001 Aug;93(2):173-183. doi: 10.1016/S0304-3959(01)00314-1. Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010 Nov;126(5):e1168-98. doi: 10.1542/peds.2010-1609. Epub 2010 Oct 4. Tsze DS, Hirschfeld G, von Baeyer CL, Bulloch B, Dayan PS. Clinically significant differences in acute pain measured on self-report pain scales in children. Acad Emerg Med. 2015 Apr;22(4):415-22. doi: 10.1111/acem.12620. Epub 2015 Mar 13. Francis Ruvuna. Unequal Center Sizes, Sample Size, and Power in Multicenter Clinical Trials. Drug Inf 2004;38:387-94.
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Harpreet Chhina, MSc
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Address
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Country
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Phone
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604-875-2000
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04642807