Study of cast index in middle third fractures of both bones of forearm in children

Abstract

Introduction: Forearm fractures are one of the most common orthopaedic injuries in paediatric age group. Normal function is often achieved with closed reduction and casting. Loss of fracture reduction is the most commonly reported complication of forearm fractures. An important modifiable risk factor for fracture redisplacement is the quality of casting, which can be measured objectively by the use of casting indices. An attempt is made to validate the role of cast index in middle third fractures of both bones of forearm in children. Materials and methods: Patients in the age group of 2 to 12 years with fracture of both bones of forearm involving the middle third treated by closed manipulation and cast application were included in the study. An above elbow cast was applied in the emergency room after closed reduction in all patients. Cast Index, defined as ratio of inner diameter of the cast in lateral view to that in anteroposterior view was measured at the fracture site in all the radiographs.The mean Cast Index in nondisplaced and displaced groups were calculated and compared. Results: Thirty children with middle third fractures of radius and ulna were included in the study. At 1 and 2 week follow-up, all but 5 cases maintained acceptable reduction. The mean cast index in 25 cases which maintained reduction was 0.75 whereas that in the group with significant displacement was 0.84. Conclusion: Majority of paediatric forearm fractures are amenable to conservative treatment. Quality of casting as expressed by indices such as cast index is one of the indicators of satisfactory outcome following middle third forearm fractures when used as a measure of risk of redisplacement.