Abstract
Introduction: Non-operative management has successfully been practised for long in diaphyseal fractures of both bones of the leg. This study attempts to establish an acceptability criteria for plaster cast in order to predict future loss of reduction and its adequacy.Materials and Methods: A total of forty subjects were included as per inclusion-exclusion criteria. Gap and cast indices were calculated in the immediate post reduction phase and at third week follow-up visit.Results: The mean values of gap and cast indices in the immediate post-reduction phase were 0.35±0.220 and 0.99±0.08 respectively and at the third week follow-up the mean value for both the parameters in those without loss of reduction were 1.11±0.50 and 1.03±0.09 respectively and in those with loss of reduction were 0.84±0.44 and 1.01±0.06 respectively.Conclusion: Gap and cast indices are not informative in assessing adequacy of reduction in diaphyseal fractures of both bones of the leg.
Highlights
Non-operative management has successfully been practised for long in diaphyseal fractures of both bones of the leg
All adult patients of either gender presenting within seven days of injury with closed displaced diaphyseal fractures of the both bones of the leg and considered suitable for non-operative treatment were included in the study
As per evidence available for forearm fractures[6], we considered cast index 0.8 and sum of gap index 0.15 as threshold indices and utilised these values for our interpretation and analysis (Fig. 1)
Summary
Non-operative management has successfully been practised for long in diaphyseal fractures of both bones of the leg. Gap and cast indices were calculated in the immediate post reduction phase and at third week follow-up visit. Conclusion: Gap and cast indices are not informative in assessing adequacy of reduction in diaphyseal fractures of both bones of the leg. Major advances have been made in this regard, an accepted parameter to assess the functional and radiological outcomes of the casting techniques in lower limb fractures is still awaited. This eventually leads to certain patients being operated upon who could have been treated effectively by non-operative means. There is a need to standardise the assessment of casting techniques to determine which patients would need operative intervention from those who were being managed without an operation, in order to avoid unnecessary complications and without compromising functional outcomes
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