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Distal forearm fractures in children: Cast index as predictor of re-manipulation

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Abstract

Background: Displaced distal forearm fractures in children have been treated in above-elbow plaster casts since the last century. Cast index (CI) has been proposed as a measure to indicate how well the cast is molded to the contours of the forearm. In this study the CI in post-manipulation radiographs were analyzed to evaluate its relevance to re-angulation of distal forearm fractures in children in different age-groups.

Materials and Methods: Out of 174 consecutive cases treated during the study period, 156 patients (114 male and 42 female) with a mean age of 9.8 years (range: 2–15 years) were included in this retrospective radiographic analysis; 18 patients were excluded for various reasons. All patients were manipulated in the operation theater under general anesthesia and a molded above-elbow cast was applied. The CI was measured on immediate post-manipulation radiographs. Children were divided into three groups according to age: group 1: <5 years, group 2: 5–10 years, and group 3: >10 years.

Results: Angulation of the fracture within the original plaster cast occurred in 30 patients (19.2%): 22/114 males and 8/42 females. The mean CI in these 30 patients who required a second procedure was 0.92±0.08, which was significantly more than the mean CI in the other children (0.77±0.07) (P<.001). The mean CI in children who underwent re-manipulation in the group 1 was 0.96, which was significantly higher than that of the other two groups, i.e., 0.90 in group 2 and 0.88 in group 3 (P<.05). A receiver operating characteristics (ROC) curve estimated the cutoff point for intraoperative CI of 0.84 when both the sensitivity and specificity of CI was high to predict re-manipulation for re-displaced fractures of the distal forearm in children in any age-group.

Conclusion: The CI is a valuable tool to assess the quality of molding of the cast following closed manipulation of forearm fractures in children. A high CI (≥0.84) in post-manipulation radiographs indicates increased risk of re-displacement of the fracture in children, especially in those under the age of 5 years and over the age of 10 years.

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Authors and Affiliations

  1. Wrexham Maelor Hospital, Wrexham, North Wales, UK

    Ujjwal K. Debnath, Abhijit R. Guha & Sreejib Das

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  1. Ujjwal K. Debnath
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  2. Abhijit R. Guha
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  3. Sreejib Das
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Correspondence to Ujjwal K. Debnath.

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Debnath, U.K., Guha, A.R. & Das, S. Distal forearm fractures in children: Cast index as predictor of re-manipulation. IJOO 45, 341–346 (2011). https://doi.org/10.4103/0019-5413.80322

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