Valving a long-arm cast results in decreased cast pressures. Univalving can produce a 60% reduction in cast pressure. Bivalving produces a 75% reduction in cast pressure. Release of the underlying cast padding produces an additional pressure reduction. Adding a cast spacer to a univalved cast obtains similar pressure reduction to a bivalved cast. Complications following closed reduction and casting of pediatric forearm fractures are rare, but they do occur. Arguably the most devastating of

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... complications is the risk of developing compartment syndrome or Volkmann contracture secondary to injury-associated swelling under a circumferential cast. [1] [2] [3] [4] The peak in swelling can develop from 4 to 24 hours following the initial cast application, 5 and as such, medical providers may not be able to identify it early because most children are discharged following closed reductions. For this reason, many providers implement prophylactic measures to minimize pressure-related complications.