Evaluation of the volar flexion ulnar deviation cast (Schede Position) in paediatric distal radius fractures: A retrospective analysis and multicenter survey

• Schede position = volar flexion and ulnar deviation • Improved correction of malalignment in Schede position compared to control group • Schede position widely used in Germany; however, no universally accepted guidelines • Lower surgery rate due to secondary displacement with Schede immobilisation • No carpal tunnel syndrome observed in children treated with Schede immobilisation Distal radius fractures are the most common fractures in children. Immobilisation in volar flexion and ulnar deviation is particularly used in the German-speaking region, where it is referred to as the Schede position, though its effectiveness is not well supported by scientific evidence. This study assessed short-term radiographic changes in angular alignment associated with Schede immobilisation compared with neutral casting and gathered data on the experience of other German paediatric surgical departments with this method of immobilisation. This retrospective study included 362 children (< 18 years) with conservatively treated distal radius fractures between 2014 and 2023. Radiological outcomes were assessed by measuring angular deviation in anteroposterior and lateral views before and after several days of immobilisation. The primary outcome was the change in angular deviation from the initial to the follow-up radiograph. Additionally, a nationwide survey was conducted among German paediatric surgical clinics to assess clinical practice. Children treated in the Schede position had greater initial lateral angular deviation, reflecting non-random treatment allocation. Schede immobilisation was associated with significantly greater median change in lateral angular deviation compared with neutral position casting (median Δ4.8° vs. Δ2.8°). In 86 % of cases in the Schede group, the angular deviation improved between the initial and follow-up radiographs, compared with 59 % in the control group. In the survey, 88 % of departments reported using the Schede position, 40 % reported applying objective criteria and 30 % reported having defined recommendations regarding flexion and deviation angles.