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Boyer, Bryan; Overton, Brent; Schrader, William C.; Riley, Patrick; Fleissner, Paul R.

doi:10.1097/00004694-200203000-00010

Cited by 15 publications

(4 citation statements)

References 7 publications

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“…(2002) suggested that all displaced fractures with an angulation of more than 15° require closed reduction 14. In this series, all children with angulation of more than 20° were advised closed reduction and cast molding.…”

Section: Discussionmentioning

confidence: 89%

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

Debnath

Guha

Das

2011

IJOO

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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.

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Section: Discussionmentioning

confidence: 89%

“…ROC estimation suggested that the cutoff point for CI should be 0.84 (when there is high sensitivity as well as specificity) for identifying children who require re-manipulation. All the previous reports have shown that the treatment failure group has a mean CI of 0.80 56142225…”

Section: Discussionmentioning

confidence: 92%

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

Debnath

Guha

Das

2011

IJOO

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“…The same has been shown for positioning the wrist in pronation/neutral/supination. 12 13 Despite this, uniform cast molding and positioning techniques were used throughout this study.…”

Section: Discussionmentioning

confidence: 99%

Cast index in predicting outcome of proximal pediatric forearm fractures

Sheikh

Malhotra

Wright

2015

IJOO

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Background:Many pediatric forearm fractures can be treated in plaster following closed reduction. The cast index (CI, a ratio of anteroposterior to lateral internal diameters of the cast at the fracture site) is a simple, reliable marker of quality of molding and a CI of >0.8 correlates with increased risk of redisplacement. Previously, CI has been applied to all forearm fractures. We hypothesize that an acceptable CI is more difficult to achieve and does not predict outcome in fractures of the proximal forearm.Materials and Methods:Seventynine cases of pediatric forearm fractures initially treated by manipulation alone over a year were included in this retrospective radiographic analysis. The CI was calculated from the post manipulation radiographs. All fractures were divided as either proximal or distal half forearm based on the location of the radius fracture. Subsequent radiographs were reviewed to assess redisplacement and reoperation.Results:The mean CI was 0.77. Remanipulation was required in five cases (6%), all distal half fractures – mean CI 0.79. CI was higher in proximal half forearm fractures (0.83 vs. 0.76, P = 0.006), nonetheless these fractures did not re-displace more than distal fractures.Conclusion:Cast index is useful in predicting redisplacement of manipulated distal forearm fractures. We found that in proximal half forearm fractures it is difficult to achieve a CI of <0.8, but increased CI does not predict loss of position in these fractures. We therefore discourage the use of CI in proximal half forearm fractures.

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“…Forearm fractures are among the most common lesions in pediatric patients [ 1 , 2 ]. 20-30% of the cases involve distal metaphysis [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Failure Predictor Factors of Conservative Treatment in Pediatric Forearm Fractures

Maccagnano

Notarnicola

Pesce

et al. 2018

BioMed Research International

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The aim of this study is to evaluate the predictive efficacy of the radiographic parameters and the relationship between the radiographic results and the clinical data. We carried out a retrospective study analyzing the data of 225 pediatric patients with forearm fractures treated conservatively. Two orthopaedists examined 4 different radiographic parameters. They compared CI and radial translation parameters at T0, in terms of indication of type of treatment and predictive efficacy. Afterwards, the two orthopaedists analyzed X-rays performed at T1, evaluating radiographic results according to radial shortening and angle parameters. From the analysis of the CI measured by Observer 1, 135 patients out of 225 had retrospective indication to conservative treatment; the frequency of failure was 18/135 (13.3%). Observer 2 indicated conservative treatment in 144 patients out of 225 and the proportion of failure was 21/144 (14.6%). As regards the radial translation, Observer 1 reported a frequency of failure of 78/225 (34.7%) and Observer 2 reported 75/222 (33.8%). Furthermore the authors detected a deficit of pronosupination for the patients considered to have failure according to radiographic results. The authors defined the greater reliability of CI with respect to the radial translation parameter and the direct relationship between radiographic failure and clinical-functional data.

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Untitled

Cited by 15 publications

References 7 publications

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

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

Cast index in predicting outcome of proximal pediatric forearm fractures

Failure Predictor Factors of Conservative Treatment in Pediatric Forearm Fractures

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