Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?

Labronici, Pedro José; Ferreira, Leonardo Termis; Filho, Fernando Claudino dos Santos; Pires, Robinson Esteves Santos; Gomes, Davi Coutinho Fonseca Fernandes; Silva, Luiz Henrique Penteado da; Gameiro, Vinícius Schott

doi:10.1016/j.injury.2016.12.007

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…The authors also acknowledged that the gap index was more sensitive, while CI and padding index showed more specificity. Similar observations were made by Labronici et al 13 However, on comparison padding had superior properties like a lower false result rate, higher sensitivity, higher positive predictive value, and lower negative likelihood ratio as compared to Canterbury index. Furthermore, the authors concluded that the three-point index and the Canterbury index were unnecessary, as the authors calculated that in 79% of cases, the cast and gap indices will suffice to predict the possibility of loss of reduction after manipulation of paediatric distal forearm fractures.…”

Section: Discussionsupporting

confidence: 86%

Importance of calculating various casting indices in predicting radiological outcomes of paediatric forearm fractures

Kharbamon¹,

Sheth

Pawar

et al. 2020

Int J Res Orthop

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Background: The present study is aimed at determining the importance of various casting indices in predicting the outcome of paediatric forearm fractures treated with closed reduction and plaster application in our department.Methods: Thirty children, aged 5 to 15 years, with closed forearm fractures not requiring surgical fixation were included to assess their casting indices and radiological outcomes using X-rays. After satisfactory casting, patients were followed up weekly till 6 weeks with anteroposterior (AP) and lateral X-ray.Results: Acceptable reduction was achieved in 26 cases, while re-manipulation was done in 4 cases. Cast Index ranged from 0.80±0.09 at first week to 0.78±0.09 at 6 weeks, Padding Index was 0.30±0.04 at first week and increased to 0.31±0.03 at 6 weeks, Canterbury Index was 1.07±0.24 at first week and 1.07±0.78 at 6 weeks, Gap Index 0.15±0.02 remained the same throughout, and Three Point Index changed from 0.81±0.08 at first week to 0.77±0.18 six weeks. Radial bow of children showed no significant change at various time points of assessment. Rotational mal-alignment was observed in 5 patients, one had a 0.5 cm radial overlap, while none had an ulnar overlap. Radial angulation was observed in five and six children on AP and lateral X-ray respectively. Ulnar angulation was seen in two and one child on AP and lateral X-ray respectively.Conclusions: Continued use of these casting indices to assess paediatric forearm cast adequacy is supported by this study.

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Section: Discussionsupporting

confidence: 86%

Importance of calculating various casting indices in predicting radiological outcomes of paediatric forearm fractures

Kharbamon¹,

Sheth

Pawar

et al. 2020

Int J Res Orthop

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“…41 Finally, anatomic reduction and high-quality casting reduce the risk of redisplacement. 30,37,38 A well molded short-arm plaster cast, with particular attention to achieve a satisfactory cast and gap index, 42 is usually sufficient for the closed treatment of distal radius fractures in this population. 43,44 If a decision is made to manage a displaced distal radius/ulna fracture with closed reduction and casting, close attention to potential loss of reduction should be done weekly for the first 2 to 3 weeks with clinical and radiographic evaluations.…”

Section: Pin Fixationmentioning

confidence: 99%

Management of Distal Radius Fractures in Adolescent Patients

Greig¹,

Silva

2021

Journal of Pediatric Orthopaedics

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Background: While management recommendations for distal radius fractures in both young and skeletally mature patients have been generally well-established, controversy still exists regarding optimal management in adolescent patients approaching skeletal maturity. Thus, the goal of this review is to analyze relevant literature and provide expert recommendations regarding the management of distal radius fractures in this patient population. Methods: A PubMed search was performed to identify literature pertaining to distal radius fractures in adolescent patients, defined as 11 to 14 years in girls and 13 to 15 years in boys. Relevant articles were selected and summarized. Results: Distal radius fractures demonstrate significant potential for remodeling of angular deformity and bayonet apposition, even in patients older than 12 years of age. Rotational forearm range of motion and functional outcomes are acceptable with up to 15 degrees of residual angulation. Closed reduction and percutaneous pinning reduces fracture redisplacement but has a high associated complication rate. There is no literature comparing plate versus pin fixation of distal radius fractures in the pediatric population, but in adults plate fixation is associated with higher cost with no improvement in long-term functional outcomes. Conclusions: Remodeling can still be expected to occur in adolescent patients, and even with residual deformity functional outcomes after distal radius fractures are excellent. Up to 15 degrees of residual angulation can be accepted before considering operative management. Smooth pins should be considered over plates as first-line operative management for unstable fractures that fail nonoperative treatment.

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“…Many casting indices are used to predict reduction loss, the most common being the cast index, three-point index and gap index 4,5 . These indexes are routinely and successfully applied during plaster application.…”

Section: Introductionmentioning

confidence: 99%

“…Values below the cut-off have been demonstrated to prevent reduction loss. 4,5 The cast index was calculated by dividing the inner diameter of the cast on the lateral view by the inner diameter of the cast on the AP view (Figure 1). The cut-off was 0.8.…”

Section: Introductionmentioning

confidence: 99%

Increase in gap index over time after reduction of unstable paediatric both-bone forearm fracture does not cause displacement

DOĞAN,

ARSLAN

2023

Acta Orthop Belg

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This study investigated the effects of changes in the gap index on fracture displacement during follow-up. Patients who underwent closed reduction and casting with a diagnosis of unstable paediatric both-bone forearm fractures and a cast index < 0.8 were retrospectively evaluated. Patients were divided into Groups 1 and 2 based on their gap index (<0.15 and >0.15, respectively). Anteroposterior and lateral displacements of the radius and ulna and the gap index of the cast were measured on the X-ray after the first reduction and on the last X-ray before plaster removal. The mean patient age (n = 94, 74 boys and 20 girls; 51 in Group 1 and 43 in Group 2) was 7.09 ± 2.66 years. Fracture union times (plaster removal) were 38.8 ± 7.1 days. The mean cast index was 0.76 ± 0.05 (0.59–0.8). Both groups had similar distributions in terms of age, sex, fracture side, anatomic location and plaster removal time (p > 0.05). No significant differences were observed in either group in any radial or ulnar angulation values at any time point or the difference between the first and last values (all p > 0.05). Moreover, the gap index difference between the first and last measurements was significantly different in both groups (p = 0.002). If the cast index remains <0.8, despite the increase in the gap index in both groups, the amount of fracture displacement was small and acceptable.

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Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?

Cited by 9 publications

References 20 publications

Importance of calculating various casting indices in predicting radiological outcomes of paediatric forearm fractures

Importance of calculating various casting indices in predicting radiological outcomes of paediatric forearm fractures

Management of Distal Radius Fractures in Adolescent Patients

Increase in gap index over time after reduction of unstable paediatric both-bone forearm fracture does not cause displacement

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