Factors Affecting Re-displacement in Pediatric Forearm Fractures and the Role of Cast Indices

Abstract

Objectives: This study aims to investigate the factors affecting theloss of reduction in pediatric diaphyseal forearm fractures and tocompare the three-point index (TPI) with the cast index, paddingindex, Canterbury index, and gap index.Patients and methods: This retrospective study, which wasconducted between January 2016 and December 2016, included159 patients (134 males, 25 females; mean age 8.1±2.8 years;range, 3 to 13 years) with diaphyseal forearm fracture. Patients’age, gender, and the level, displacement, and location of thefractures were recorded. The presence of anatomic reduction,a straight ulnar border, and the cast type (banana or box type) werechecked after the reduction. The TPI, cast index, padding index,Canterbury index, and gap index were measured.Results: Fifty-two patients (32.7%) experienced loss of reductionduring the follow-up. Displaced fractures of both the radius and theulna, cast type-banana, anatomical reduction, straight ulnar border,TPI, cast index, padding index, and Canterbury index were foundto be associated with re-displacement.Conclusion: Although cast indices can be used as a beneficialclinical tool in predicting the loss of reduction in the treatmentof pediatric forearm fractures, they may not be sufficient whenused alone. Obtaining a more accurate result may be possible byassessing several parameters such as the presence of an anatomicreduction, box-type casting, and TPI together.