Re-displacement and cast index in distal forearm fractures in children

Abstract

Introduction: Forearm fractures in children treated by closed reduction and immobilization with plaster cast provide satisfactory outcome. Prediction of re-displacement in conservative fracture treatment would be a gift for orthopaedic surgeon. Cast index (CI) is a simple and reliable marker to predict re-displacement of fracture. It is calculated by measuring the ratio of the internal antero-posterior and lateral diameter of the cast at the fracture site. Materials and Methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital on 113 patients below 13 years of age with forearm fractures. They were treated conservatively by closed reduction and above elbow casting. Cast index was measured from the post-manipulation radiographs and then followed up weekly to check for re-displacement. All fractures were divided as proximal and distal based on the location of the radius fracture. Open fractures, patient with distal neurovascular deficit or associated with other fractures are excluded.Results: Maximum incidence of pediatric forearm fractures was found in 8-12 years age group. Out of 113 patients, incidence in males (68.14%) was higher than females (31.85%) and distal fractures (73.45%) are more than proximal (26.55%). Mean cast index in distal fractures which were displaced was 0.85. Out of 83 distal forearm fractures 9 were re-displaced. Re-displacement was the only complication. Discussion: Cast Index of >0.8 correlates with increased risk of re-displacement. Cast index stays a clinically useful tool to predict re-displacement particularly in distal fractures.Conclusion: Achieving