Neurobionplus
Home About Journal AHEAD OF PRINT Current Issue Back Issues Instructions Submission Search Subscribe Blog    
Login 

Users Online: 1893 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
ORIGINAL ARTICLE
Year : 2011  |  Volume : 45  |  Issue : 4  |  Page : 341-346

Distal forearm fractures in children: Cast index as predictor of re-manipulation


Wrexham Maelor Hospital, Wrexham, North Wales, United Kingdom

Correspondence Address:
Ujjwal K Debnath
23, Barons Court Road, Cardiff
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.80322

Rights and Permissions

Background: Displaced distal forearm fractures in children have been treated in above-elbow plaster casts since the last century. Cast index (CI) has been proposed as a measure to indicate how well the cast is molded to the contours of the forearm. In this study the CI in post-manipulation radiographs were analyzed to evaluate its relevance to re-angulation of distal forearm fractures in children in different age-groups. Materials and Methods: Out of 174 consecutive cases treated during the study period, 156 patients (114 male and 42 female) with a mean age of 9.8 years (range: 2-15 years) were included in this retrospective radiographic analysis; 18 patients were excluded for various reasons. All patients were manipulated in the operation theater under general anesthesia and a molded above-elbow cast was applied. The CI was measured on immediate post-manipulation radiographs. Children were divided into three groups according to age: group 1: <5 years, group 2: 5-10 years, and group 3: >10 years. Results: Angulation of the fracture within the original plaster cast occurred in 30 patients (19.2%): 22/114 males and 8/42 females. The mean CI in these 30 patients who required a second procedure was 0.92±0.08, which was significantly more than the mean CI in the other children (0.77±0.07) (P<.001). The mean CI in children who underwent re-manipulation in the group 1 was 0.96, which was significantly higher than that of the other two groups, i.e., 0.90 in group 2 and 0.88 in group 3 (P<.05). A receiver operating characteristics (ROC) curve estimated the cutoff point for intraoperative CI of 0.84 when both the sensitivity and specificity of CI was high to predict re-manipulation for re-displaced fractures of the distal forearm in children in any age-group. Conclusion : The CI is a valuable tool to assess the quality of molding of the cast following closed manipulation of forearm fractures in children. A high CI (≥0.84) in post-manipulation radiographs indicates increased risk of re-displacement of the fracture in children, especially in those under the age of 5 years and over the age of 10 years.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed4756    
    Printed129    
    Emailed5    
    PDF Downloaded213    
    Comments [Add]    
    Cited by others 3    

Recommend this journal