Paediatric forearm and distal radius fractures: risk factors and re-displacement—role of casting indices
- 456 Downloads
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.
- 5.Schmittenbecher PP (2005) State-of-the-art treatment of forearm shaft fractures. Injury 36:S-A25–34Google Scholar
- 7.Bae DS (2008) Pediatric distal radius and forearm fractures. J Hand Surg 33A:1911–1923Google Scholar
- 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
- 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
- 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