ObjectiveThe aim of this study was to evaluate the most important factors which can cause “tight cast syndrome’’ (TCS) in pediatric patients with distal radius fractures.MethodsPatients, who were at or under 15 years old and treated conservatively with an diagnosis of distal radius fracture between August 2015 and August 2017 were included in to the study. Fifty four patients, who had been found to experience TCS were accepted as group 1 and sixty-two patients without TCS as group 2. Cast index, pre-/post reduction translation, pre-/post reduction angulation, localization and displacement of the fracture, need for re-manipulation, and presence of associated distal ulna fracture were evaluated for both groups. Statistical analysis was performed to evaluate cut off value for cast index values for both TCS and loss of reduction and logistic regression analysis of the other possible factors.ResultsPre-/post-reduction translation (over 50% and 10%, respectively) (odds ratios:0.167 and 0.524, respectively), a cast index value below than 0.775 (odds ratio:3.080), displaced type fracture (odds ratio:8.028), presence of re-manipulation (odds ratio:0.131) and associated distal ulna fracture (odds ratio:2.029) were found to be statistically significantly important for the occurrence of TCS. The most important factors were decreased cast index value and presence of initially displaced type fracture. Loss of reduction (LOR) risk was found to be increased in patients with a cast index value of greater than 0.875.ConclusionOne should be very careful when following a pediatric patient who have a displaced distal radius fracture which has initial/post reduction translation in AP plane, which is associated with distal ulna fracture, which required re-manipulation and most importantly which cast index is under than 0.775 in terms of occurrence of TCS. We recommend obtaining a cast index value between 0.775 and 0.875 to prevent both TCS and LOR.Level of evidenceLevel III, Therapeutic study.

The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study

Background: The amount of intra-articular displacement of the fracture is the main issue when deciding the treatment method between conservative or surgical means in intra-articular fractures. In this study, we aimed to determine the intraobserver and interobserver reliability of measuring intra-articular displacement and to compare the digital radiographic and computed tomographic (CT) evaluations in distal tibia intra-articular epiphyseal fractures. Methods: Thirty-seven patients with digital radiography and CT scans were included in the study. Four sets were prepared with these images. Two of four sets were prepared as ankle radiographs, and the other two sets were prepared with CT scan views. Five observers were asked to measure the intra-articular displacement of the fractures in millimeters and also to make a decision between displacement amounts over or under 2 mm. Intraclass correlation coefficient scores were calculated for evaluation of intraobserver reliability, and Fleiss kappa values were calculated for interobserver reliability evaluations. A value greater than 0.75 was accepted as excellent agreement; 0.75 to 0.40 as intermediate to good agreement; and below 0.40 as poor agreement. Results: There were 15 Salter-Harris type 3, 13 Salter-Harris type 4, seven triplanar, and two Tillaux-Chaput fractures. Both intraobserver and interobserver reliabilities were slightly higher for CT scan evaluations. Amounts of displacement were found to be measured higher after CT scan evaluations other than radiographs. After the measurement of joint displacements on CT scans, it was observed that the measurements found below 2 mm on the digital radiograph measurement changed to greater than or equal to 2 mm in 16.4% of the patients. Conclusions: This study confirmed that digital radiographs cannot replace CT scans for the measurement of intra-articular displacement in ankle epiphyseal fractures.