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Factors Responsible for Redisplacement of Pediatric Forearm Fractures Treated by Closed Reduction and Cast

Role of casting indices and three point index

  • Symposium - Pediatric Trauma
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Pediatric forearm fractures are still considered an enigma in view of their propensity to redisplace in cast. The redisplacement may be a potential cause for malalignment. We prospectively analyzed the role of risk factors and above casting indices in predicting significant redisplacement of pediatric forearm fractures treated by closed reduction and cast.

Materials and Methods

113 patients of age range 2–13 years with displaced forearm fractures, treated by closed reduction and cast were included in this prospective study. Prereduction and postreduction angulation, translation, and shortening were noted. In addition, for distal metaphyseal fractures, obliquity angle was noted. In postreduction X-ray, apart from fracture variables, casting indices were also noted (cast index [CI] for all patients with three-point index [TPI] and second metacarpal radius angle in addition for distal metaphyseal fractures). In 2nd week, X-rays were again obtained to check for significant redisplacement. These patients were managed with remanipulation and casting or were operated if remanipulation failed. Comparison of various risk factors was made between patients with significant redisplacement and those which were acceptably reduced. A subgroup analysis of patients with distal metaphyseal fractures was done.

Results

Thirteen (11.5%) patients had significant redisplacement; all of them required remanipulation. No association with respect to age, sex, level of fracture, side of injury, surgeon’s experience, number of bones fractured, and injury to definitive cast interval was seen. The presence of complete displacement in any of the plane in either of the bones was seen to be highly significant predictor of redisplacement (P < 0.001). Postreduction angulation more than 10° in any plane in either of the bone and fracture obliquity angle in distal metaphyseal fracture also had a highly significant association with redisplacement. There was a significant difference in the mean values of all three casting indices assessed. TPI was the most sensitive casting index (87.5%).

Conclusions

Conservative management with aim of anatomical reduction, especially in patients with complete displacement, should be the approach of choice in closed pediatric forearm fractures. Casting indices are good markers of quality of cast.

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References

  1. Bohm ER, Bubbar V, Yong Hing K, Dzus A. Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am 2006;88:1–8.

    PubMed  Google Scholar 

  2. Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am 2006;88:9–1.

    PubMed  Google Scholar 

  3. Proctor MT, Moore DJ, Paterson JM. Redisplacement after manipulation of distal radial fractures in children. J Bone Joint Surg Br 1993;75:453–4.

    Article  CAS  PubMed  Google Scholar 

  4. Zamzam MM, Khoshhal KI. Displaced fracture of the distal radius in children: Factors responsible for redisplacement after closed reduction. J Bone Joint Surg Br 2005;87:841–3.

    Article  CAS  PubMed  Google Scholar 

  5. Jones K, Weiner DS. The management of forearm fractures in children: A plea for conservatism. J Pediatr Orthop 1999;19:811–5.

    PubMed  CAS  Google Scholar 

  6. Voto SJ, Weiner DS, Leighley B. Use of pins and plaster in the treatment of unstable pediatric forearm fractures. J Pediatr Orthop 1990;10:85–9.

    Article  CAS  PubMed  Google Scholar 

  7. Chan CF, Meads BM, Nicol RO. Remanipulation of forearm fractures in children. N Z Med J 1997;110:249–50.

    PubMed  CAS  Google Scholar 

  8. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM, et al. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: A prospective, randomized study. J Pediatr Orthop 2005;25:490–4.

    Article  PubMed  Google Scholar 

  9. Mehlman CT, Wall EJ. Injuries to the shafts of the radius and ulna. In: Beaty JH, Kasser JR, editors. Rockwood and Wilkins’ Fractures in Children: Text Plus Integrated Content Website. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 347–402.

  10. Price CT, Knapp DR. Osteotomy for malunited forearm shaft fractures in children. J Pediatr Orthop 2006;26:193–6.

    Article  PubMed  Google Scholar 

  11. Mani GV, Hui PW, Cheng JC. Translation of the radius as a predictor of outcome in distal radial fractures of children. J Bone Joint Surg Br 1993;75:808–11.

    Article  CAS  PubMed  Google Scholar 

  12. Haddad FS, Williams RL. Forearm fractures in children: Avoiding redisplacement. Injury 1995;26:691–2.

    Article  CAS  PubMed  Google Scholar 

  13. Chess DG, Hyndman JC, Leahey JL, Brown DC, Sinclair AM. Short arm plaster cast for distal pediatric forearm fractures. J Pediatr Orthop 1994;14:211–3.

    Article  CAS  PubMed  Google Scholar 

  14. Bhatia M, Housden PH. Re-displacement of paediatric forearm fractures: Role of plaster moulding and padding. Injury 2006;37:259–68.

    Article  PubMed  Google Scholar 

  15. Malviya A, Tsintzas D, Mahawar K, Bache CE, Glithero PR. Gap index: A good predictor of failure of plaster cast in distal third radius fractures. J Pediatr Orthop B 2007;16:48–52.

    Article  PubMed  Google Scholar 

  16. Alemdaroğlu KB, Iltar S, Cimen O, Uysal M, Alagöz E, Atlihan D, et al. Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am 2008;90:1224–30.

    Article  PubMed  Google Scholar 

  17. Monga P, Raghupathy A, Courtman NH. Factors affecting remanipulation in paediatric forearm fractures. J Pediatr Orthop B 2010;19:181–7.

    Article  PubMed  Google Scholar 

  18. Edmonds EW, Capelo RM, Stearns P, Bastrom TP, Wallace CD, Newton PO, et al. Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: Utility of the second metacarpal-radius angle. J Child Orthop 2009;3:375–81.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McQuinn AG, Jaarsma RL. Risk factors for redisplacement of pediatric distal forearm and distal radius fractures. J Pediatr Orthop 2012;32:687–92.

    Article  PubMed  Google Scholar 

  20. Hang JR, Hutchinson AF, Hau RC. Risk factors associated with loss of position after closed reduction of distal radial fractures in children. J Pediatr Orthop 2011;31:501–6.

    Article  PubMed  Google Scholar 

  21. Yang JJ, Chang JH, Lin KY, Lin LC, Kuo CL. Redisplacement of diaphyseal fractures of the forearm after closed reduction in children: A retrospective analysis of risk factors. J Orthop Trauma 2012;26:110–6.

    Article  PubMed  Google Scholar 

  22. Pretell Mazzini J, Beck N, Brewer J, Baldwin K, Sankar W, Flynn J, et al. Distal metaphyseal radius fractures in children following closed reduction and casting: Can loss of reduction be predicted? Int Orthop 2012;36:1435–40.

  23. Iltar S, Alemdaroglu KB, Say F, Aydogan NH. The value of the three-point index in predicting redisplacement of diaphyseal fractures of the forearm in children. Bone Joint J 2013;95-B: 563–7.

  24. Pretell Mazzini J, Rodriguez Martin J. Paediatric forearm and distal radius fractures: Risk factors and re-displacement – Role of casting indices. Int Orthop 2010;34:407–12.

    Article  PubMed  Google Scholar 

  25. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146–56.

    Article  CAS  PubMed  Google Scholar 

  26. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am 2008;33:1911–23.

    Article  PubMed  Google Scholar 

  27. Rockwood CA Jr., Wilkins KE, Beaty JH, editors. Fractures of the shaft of the distal radius and ulna. In: Fractures in Children. Philadelphia: Lippincott Raven Publishers; 1996. p. 449–652.

  28. Bochang C, Katz K, Weigl D, Jie Y, Zhigang W, Bar-On E, et al. Are frequent radiographs necessary in the management of closed forearm fractures in children? J Child Orthop 2008;2:217–20.

  29. Johari AN, Sinha M. Remodeling of forearm fractures in children. J Pediatr Orthop B 1999;8:84–7.

    PubMed  CAS  Google Scholar 

  30. Younger AS, Tredwell SJ, Mackenzie WG. Factors affecting fracture position at cast removal after pediatric forearm fracture. J Pediatr Orthop 1997;17:332–6.

    PubMed  CAS  Google Scholar 

  31. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990;10(6);705–12.

  32. Khan S, Sawyer J, Pershad J. Closed reduction of distal forearm fractures by pediatric emergency physicians. Acad Emerg Med 2010;17:1169–74.

    Article  PubMed  Google Scholar 

  33. Kamat AS, Pierse N, Devane P, Mutimer J, Horne G. Redefining the cast index: The optimum technique to reduce redisplacement in pediatric distal forearm fractures. J Pediatr Orthop 2012;32:787–91.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

    Puneet Mishra, Aditya Nath Aggarwal, Rahul Anshuman & Ravi Sreenivasan

  2. Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

    Rajesh Arora

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  1. Rajesh Arora
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  2. Puneet Mishra
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  3. Aditya Nath Aggarwal
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  4. Rahul Anshuman
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  5. Ravi Sreenivasan
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Correspondence to Rajesh Arora.

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Arora, R., Mishra, P., Aggarwal, A.N. et al. Factors Responsible for Redisplacement of Pediatric Forearm Fractures Treated by Closed Reduction and Cast. IJOO 52, 536–547 (2018). https://doi.org/10.4103/ortho.IJOrtho_382_17

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_382_17

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