Introduction: Prediction of Re-displacement of pediatric forearm fractures would be a boon for orthopaedic surgeons treating them conservatively. Cast index (CI), described by Chess et al. is calculated by measuring the internal antero-posterior (AP) diameter of the cast (excluding padding) at the level of the fracture and dividing it by the internal lateral diameter of the cast (excluding padding) which could be used as a tool to predict the re-displacement of fracture if it is maintao <0.8. Aims: The aim of the present study is to evaluate the role of cast index in predicting the re-displacement in pediatric forearm fracture. Materials and Methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, Assam. 83 paediatric patients ranging from 0 to 16 yrs with forearm fractures who met the inclusion criteria were recruited in our study. Patients with open fractures and with distal neurovascular deficit were excluded from our study. The fractures were treated with closed reduction with above elbow casts after manipulation. The cast index was measured immediately following casting on x-ray and patient was followed up weekly to check for redisplacement. Results: Out of 83 patients, proximal and distal fractures were 14 (18.07%) and 69 (81.92%) respectively. Mean cast index in proximal fractures and distal fractures which were displaced was 0.85 and 0.75 respectively. Out of 69 distal forearm fractures 7 were re-displaced and were re-manipulated, on the other hand only 1 out of 14 proximal forearm fracture was re-displaced and re-manipulated. Conclusion: Distal forearm fractures with cast index >0.8 were more likely toget re-displaced than with <0.8. It is difficult to achieve a cast index <0.8 in proximal forearm fractures, cast index < or > 0.8 does not predict the risk of re-displacement and re-manipulation in proximal forearm fractures. So, its use to predict the re-displacement should be discouraged in proximal fractures. It should be used to predict redisplacement in distal forearm fractures.
Introduction: Serum biomarkers such as Alkaline Phosphatase can be used to assess bone-forming activity. Studies have shown that the measurement of bone formation markers such as Serum Alkaline phosphatase during the fracture healing process could enhance the accuracy of the bone healing stage assessment, allowing early detection in patients at risk of the development of delayed union or nonunion. Aims: To evaluate the changes of serum alkaline phosphatase levels during healing of diaphyseal fractures of long bones in adults treated operatively. Materials and methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, Assam. 91 adult patients ranging from 18 yrs to 50 yrs with diaphyseal fractures of the tibia or femur who met the inclusion criteria were recruited in our study. Patients with systemic diseases and drugs intake which could affect the bone turnover were excluded from our study. The fractures were treated with closed reduction or open reduction and internal fixation with intramedullary nailing. The biomarker serum Alkaliine Phosphatase was measured at definite intervals until bony union was achieved clinico-radiologically. Results: Out of the 91 patients, 36 patients (Group A=normal healing group) achieved bony union by the end of 6 months. 50 patients (Group B=delayed healing group) where bony union was not completed by the end of 6 months but completed by 9 months. 5 patients (Group C=non-union group) where bony union was not seen even by the end of 9 months. At the time of admission, mean serum ALP levels remained within normal limits in all the three groups. Mean serum ALP levels followed the same pattern in Group A and Group B reaching the maximum levels at 3 rd week post trauma but the mean serum ALP at every selected interval was significantly higher in Group A than Group B. In Group A, the mean serum ALP returned to baseline level by the end of 6 months, whereas, in Group B patients, the mean serum ALP remained elevated even by the end of 6 months. In group C patients, the mean serum ALP level did not rise significantly throughout the period of study. Conclusion: Thus, the determination of serum ALP levels during the fracture healing could be an additional tool to help predict fractures at risk of delayed union or non-union of diaphyseal fractures therby allowing the clinician to step in early and take appropriate intervention.
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