International Orthopaedics

, Volume 34, Issue 3, pp 407–412 | Cite as

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



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 re-displacement 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.


  1. 1.
    Zamzam MM, Khoshhal KI (2005) Displaced fracture of the distal radius in children: factors responsible for re-displacement after closed reduction. J Bone Joint Surg 87(6):841–843CrossRefGoogle Scholar
  2. 2.
    Bochang C, Jie Y, Zhigang W, Weigl D, Bar-On KK (2005) Immobilisation of forearm fractures in children: extended versus flexed elbow. J Bone Joint Surg Br 87-B:994–996CrossRefGoogle Scholar
  3. 3.
    Hove LM, Brudvik C (2008) Displaced paediatric fractures of the distal radius. Arch Orthop Trauma Surg 128:55–60CrossRefPubMedGoogle Scholar
  4. 4.
    Rodriguez-Merchán EC (2005) Pediatric fractures of the forearm. Clin Orthop Relat Res 432:65–72CrossRefPubMedGoogle Scholar
  5. 5.
    Schmittenbecher PP (2005) State-of-the-art treatment of forearm shaft fractures. Injury 36:S-A25–34Google Scholar
  6. 6.
    Alemdaroglu KB, Iltar S, Çimen O, Uysal M (2008) Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg 90:1224–1230CrossRefPubMedGoogle Scholar
  7. 7.
    Bae DS (2008) Pediatric distal radius and forearm fractures. J Hand Surg 33A:1911–1923Google Scholar
  8. 8.
    Zimmermann R, Gschwenter M, Kralinger F, Arora R, Gabl M, Pechlaner S (2004) Long-term results following pediatric forearm fracture. Arch Orthop Trauma Surg 124:179–186CrossRefPubMedGoogle Scholar
  9. 9.
    Boyer BA, Overton B, Schrader W, Riley P, Fleissner P (2002) Position of immobilization for pediatric forearm fractures. J Pediatr Orthop 22:185–187CrossRefPubMedGoogle Scholar
  10. 10.
    Proctor MT, Moore DJ, Paterson JMH (1993) Re-displacement after manipulation of distal radial fractures in children. J Bone Joint Surg Br 75-b:453–454Google Scholar
  11. 11.
    Haddad FS, Williams RL (1995) Forearm fractures in children: avoiding re-displacement. Injury 26(10):691–692CrossRefPubMedGoogle Scholar
  12. 12.
    Bhatia M, Housden PH (2006) Re-displacement of paediatric forearm fractures: role of plaster molding and padding. Injury Int J Care Injured 37:259–268Google Scholar
  13. 13.
    Chess DG, Hyndman JC, Leahey JL, Brown DCS, Sinclair AM (1994) Short arm plaster cast for distal pediatric forearm fractures. J Pediatr Orthop 14:211–213PubMedGoogle Scholar
  14. 14.
    Celebi I, Muratli HH, Dogan O, Yagmurlu MF, Aksahin E, Bicimoglu A (2007) The results of intramedullary nailing in children who developed re-displacement during cast treatment of both-bone forearm fractures. Acta Orthop Traumatol Turc 41(3):175–182PubMedGoogle Scholar
  15. 15.
    Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE (2008) Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma 65:109–115CrossRefPubMedGoogle Scholar
  16. 16.
    Reichmann W (1978) Distal radial fracture in childhood. Handchirurgie 10(4):179–181PubMedGoogle Scholar
  17. 17.
    Noonan KJ, Price CT (1998) Forearm and distal radius fractures in children. J Am Acad Orthop Surg 6(3):146–156PubMedGoogle Scholar
  18. 18.
    Malviya A, Tsintzas D, Mahawar K, Bache CE, Glithero PR (2007) Gap index: a good predictor of failure of plaster cast in distal third radius fractures. J Pediatr Orthop B 16(1):48–52PubMedGoogle Scholar
  19. 19.
    Edmonds EW, Capelo RM, Stearns P, Bastrom TP, Wallace CD, Newton PO (2009) Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal–radius angle. J Child Orthop 3:375–381Google Scholar
  20. 20.
    Webb GR, Galpin RD, Armstrong DG (2006) Comparison of short and long plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg 88A:9–17CrossRefGoogle Scholar
  21. 21.
    Singh S, Bhatia M, Housden P (2008) Cast and padding indices used for clinical decision making in forearm fractures in children. Acta Orthop 79(3):386–389CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Orthopaedic Surgery12 de Octubre HospitalMadridSpain
  2. 2.Trauma & OrthopaedicsInfanta Leonor HospitalMadridSpain

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