Paediatric forearm and distal radius fractures: risk factors and re-displacement—role of casting indices

Mazzini, Juan Pretell; Martín, Juan Rodríguez

doi:10.1007/s00264-009-0904-0

Cited by 66 publications

(55 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…is a useful casting index for predicting re-displacement in forearm fractures 24. This is the only study which suggests that this index is sensitive one 23. The authors nevertheless opined that these casting indices should not be interpreted in isolation but should be used in conjunction with fracture characteristics and patient factors 23.…”

Section: Discussionmentioning

confidence: 95%

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

Debnath

Guha

Das

2011

IJOO

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 95%

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

Debnath

Guha

Das

2011

IJOO

View full text Add to dashboard Cite

show abstract

“…At our department the vast majorities of cases are treated with only a splint or closed reduction followed by a splint [2]. The treatment guidelines for the ED doctors at the hospital can, in a simplified manner, be divided into four groups:

No fracture.

Advised treatment: No splint or immobilization.

A buckle or greenstick fracture with acceptable angulation.

Advised treatment: A dorsal forearm plaster of Paris splint for 3 weeks that is removed by the parents.

…”

Section: Methodsmentioning

confidence: 99%

Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound

et al. 2017

View full text Add to dashboard Cite

BackgroundIn children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training.MethodsPhysicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively.ResultsOne hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions.ConclusionsIn the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group.Level of EvidenceLevel III. Diagnostic study of non-consecutive patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-017-0066-z) contains supplementary material, which is available to authorized users.

show abstract

“…Fractures in children heal more rapidly than in adults [2]. This is explained in part by the osteogenic potential of the periosteum and the magnitude of the vascular response in children.…”

Section: Physiological Featuresmentioning

confidence: 99%

“…The most common sites of fracture are the distal forearm and hand, which account for 50% of paediatric fractures. Overall, the radius is the most commonly fractured long bone [2], followed by the humerus. In the lower extremity, the tibia is more commonly affected than the femur.…”

Section: Introductionmentioning

confidence: 99%

Clinical application of locked plating system in children. An orthopaedic view

Pretell-Mazzini¹,

Zafra-Jimenez²,

Martín

2010

International Orthopaedics (SICOT)

Self Cite

View full text Add to dashboard Cite

In recent years, the locked plating system has gained favour in the treatment of certain fractures in adults; however, there is not much information regarding its use in children. We think there could be some advantages and applications such as: an alternative to external fixation, the bridge plating technique, unicortical screws, removal of hardware, metadiaphyseal fractures, periarticular fractures, poor quality bone, and allograft fixation. However, there are some disadvantages to keep in mind and the final decision for using it should be based on the osteosynthesis method principle the surgeon would like to apply. In this review article we discuss the up-to-date possible clinical applications and issues of this system.

show abstract

Paediatric forearm and distal radius fractures: risk factors and re-displacement—role of casting indices

Cited by 66 publications

References 19 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

Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound

Clinical application of locked plating system in children. An orthopaedic view

Contact Info

Product

Resources

About