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Acta Ortopédica Mexicana

ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología
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2010, Number 3

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Acta Ortop Mex 2010; 24 (3)

Usefulness of the cast index and padding index for the prognosis of pediatric forearm fractures

Ortega VMA, Robles VA, Bermúdez MD
Full text How to cite this article

Language: Spanish
References: 11
Page: 146-150
PDF size: 207.87 Kb.


Key words:

fracture, child, forearm, external fixationcasts, surgical, radiology, evaluation, utility.

ABSTRACT

Background: The most frequent fractures in pediatric patients are those of the mid or distal shaft of the radius and ulna. Most of them can be treated with closed reduction and a brachio-palmar cast, but sometimes redisplacement or angulation occur within the first few weeks. X-ray measurements to foresee these complications have been designed; this paper focuses on their certainty and usefulness. Methods: Twenty-four patients ages 2-14 years of age were included, all of them with closed fractures of the mid or distal shaft of the radius and ulna treated with reduction maneuvers under anesthesis and placement of an brachio-palmar cast. Measurements of the cast, padding and Canterbury indices were performed, which were compared with the clinical and X-ray results at three weeks. The sensitivity, specificity, and the positive and negative predictive value were calculated. Results: X-ray measurements had a sensitivity of 43%, a specificity of 88%, a positive predictive value of 60% and a negative predictive value of 79%. Conclusion: The results of the measurements are consistent with the findings of other studies, which proves their usefulness; their use should therefore be encouraged to prevent complications like the displacement or angulation of forearm fractures in pediatric patients.


REFERENCES

  1. Jones K, Weiner DS, Leighley B: The management of forearm fractures in children: A plea for conservatism. J Pediatr Orthop 1999; 19: 811-22.

  2. Webb GR, Galpin RD, Armstrong DG: Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am 2006; 88: 9-17.

  3. Charnley J: The closed treatment of common fractures. Baltimore: Williams and Wilkins; 1968: 116-27.

  4. Zamzam MM, Khoshhal KI: Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction. J Bone Joint Surg Br 2005; 87: 841-3.

  5. Proctor MT, Moore DJ, Paterson JMH: Redisplacement after manipulation of distal radial fractures in children. J Bone Joint Surg Br 1993; 75: 453-4.

  6. Wilkins KE: Nonoperative management of pediatric upper extremity fractures. Tech Orthop 2005; 20(2): 115-41.

  7. Bhatia M, Housden PL: Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding. Injury 2006; 37: 259-68.

  8. Chess DG, Hyndman JC, Leahey JL, Brown DC, Sinclair AM: Short arm plaster cast for distal pediatric forearm fractures. J Pediatric Orthop 1994; 14: 211-3.

  9. Malviya A, Taintzas D, Mahawar K, Bache CE, Glithero PR: Gap index: a good predictor of failure of plaster cast in distal third radius fractures. J Pediatr Orthop B 2007; 16: 48-52.

  10. Roberts JA: Angulation of the radius in children’s fractures. J Bone Joint Surg Br 1986; 68: 751-4.

  11. Alemdaro˘glu KB, Iltar S, Cimen O, Uysal M, Alagöz E, Atlihan D: Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am 2008; 90: 1224-30.




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Acta Ortop Mex. 2010 May-Jun;24