Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding

Bhatia, Maneesh; Housden, Philip

doi:10.1016/j.injury.2005.10.002

Cited by 73 publications

(89 citation statements)

References 9 publications

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“…A properly padded and moulded cast minimises the risk of re-displacement [21]. In order to assess the quality of Table 2 Odds ratios for a simple model predicting failure based on re-displacement criteria after closed reduction and casting of a distal metaphyseal radius fracture in children over 11 years of age casting, several casting indices have been described such as the cast index [6], padding index [21], gap index [22], Canterbury index [21] and the three-point index [8].…”

Section: Discussionmentioning

confidence: 99%

“…In order to assess the quality of Table 2 Odds ratios for a simple model predicting failure based on re-displacement criteria after closed reduction and casting of a distal metaphyseal radius fracture in children over 11 years of age casting, several casting indices have been described such as the cast index [6], padding index [21], gap index [22], Canterbury index [21] and the three-point index [8]. Alemdaroglu et al [8] found that the three-point index was superior to the other radiographic indices with regard to prediction of re-displacement.…”

Section: Discussionmentioning

confidence: 99%

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Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Mazzini

Beck

Brewer

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to identify factors which contribute to loss of reduction (LOR). Methods Outpatient records and initial, post-reduction (PR) and follow-up radiographs of patients with a distal radial metaphyseal fracture were reviewed to determine demographic factors; fracture characteristics (obliquity, comminution, intact ulna); three-point cast index (3PI); and initial, PR, and follow-up displacement (angulation and translation in the sagittal and coronal planes). Univariate and multivariate regression were used to identify significant risk factors for LOR. Results A total of 161 patients were included in our series (119 boys and 42 girls). Fifty-seven (35%) patients met the criteria for LOR. Multivariate logistic regression revealed that patients over 14 years old were 4.8 times more likely (p00.01) to lose reduction, and those with more than 10% PR translation in the sagittal plane were four times more likely (p00.03) to lose reduction. In younger patients, initial coronal translation and PR sagittal translation were independent risk factors. Patients with over 10% initial translation in the coronal plane were 2.4 times more likely (p00.01) to lose reduction, and those with over 10% PR translation in the sagittal plane were 2.7 times more likely (p00.03) to lose reduction. Three point cast index was not found to be a significant risk factor (1.64 vs. 1.57, p00.43).Conclusion Our study, the largest dedicated series of distal radial metaphyseal fractures, indicates that loss of reduction is common. Our analysis suggests that an anatomical reduction, which minimises residual translation, is the most important variable in preventing a loss of reduction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Mazzini

Beck

Brewer

et al. 2012

International Orthopaedics (SICOT)

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“…Maintaining acceptable reduction is not always possible and re-displacement or re-angulation during cast treatment may occur; this is the most commonly reported complication in paediatric forearm fractures [2,[11][12][13]. Very high rates of unacceptable degrees of displacement after the initial fracture reduction have been reported.…”

Section: Introductionmentioning

confidence: 99%

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

Mazzini

Martín

2009

International Orthopaedics (SICOT)

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Forearm fractures represent one of the most common fractures in children aside from clavicle fractures, and the distal radius is the most common fracture site accounting for 20-30% of these fractures. Maintaining acceptable reduction is not always possible, and redisplacement or re-angulation is the most commonly reported complication. Factors leading to this complication can be broadly divided into three groups: fracture-, surgeon-and patient-related. The quality of casting has been historically measured subjectively. The description of several casting indices by different authors has been a major undertaking, attempting to address objective assessment of this factor. The following have been described: cast index, padding index, gap index, three point index and second metacarpal-radius angle. For distal radius fractures we think that the three point index is the most valuable measurement for predicting re-displacement among surgeon related factors; this index has not been used in forearm fractures in which the rest of the indices seem to be useful in predicting re-displacement. The casting indices should not be interpreted as a separate issue but in conjunction with fracture characteristics and patient factors.

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“…The pivotal role of cast quality has already been addressed by other authors [4]. Can methodical differences in applying the plaster cast, therefore, explain the abovementioned differences in the percentage of re-dislocations?…”

Section: Dear Editormentioning

confidence: 90%

Reply to “Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated” by van Egmond PW, Schipper IB, van Luijt PA in Eur J Orthop Surg Traumatol. 2012 Apr;22(3):201–207

Singer

Peschaut

Kraus

et al. 2012

Eur J Orthop Surg Traumatol

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Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding

Cited by 73 publications

References 9 publications

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

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

Reply to “Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated” by van Egmond PW, Schipper IB, van Luijt PA in Eur J Orthop Surg Traumatol. 2012 Apr;22(3):201–207

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