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. 2020 Mar-Apr;11(2):269-274.
doi: 10.1016/j.jcot.2019.04.022. Epub 2019 May 2.

Predictors for losing reduction after reposition in conservatively treated both-bone forearm fractures in 38 children

Joris J W Ploegmakers  1 , Wilhelmina M G A C Groen  2 , Robert Haverlag  3 , Sjoerd K Bulstra  1
Affiliations

Predictors for losing reduction after reposition in conservatively treated both-bone forearm fractures in 38 children

Joris J W Ploegmakers et al. J Clin Orthop Trauma. 2020 Mar-Apr.

Erratum in

Abstract

Backgrounds: Alignment loss after reduction and cast immobilisation of angulated and/or complete displaced forearm fractures is challenging. Many authors have tried to describe risk factors and create indices (initial angulation, initial complete displacement, lack of anatomic reduction, cast and padding index) in order to identify those fractures that are prone to losing their alignment during treatment.

Methods: This retrospective case-control study included children sustaining both-bone forearm fractures treated by closed reduction and cast immobilisation. Basic characteristics were recorded and radiographs evaluated to measure displacement and angulation before and after reduction, cast index and padding index. The primary outcome was loss of reduction during the immobilisation period.

Results: Group A consisted of 22 patients in whom >5° reduction loss was seen during cast immobilisation. Group B consisted of 16 patients with <5° reduction loss. After multivariate analyses we found group A included more broken cortices, with a statistically significant higher number of initial displaced fractures (p < 0.001 and p = 0.010) and residual displacement (p = 0.022). The cast and padding index did not differ significantly between groups (p = 0.77 and 0.15 respectively).

Conclusions: Cast and padding index did not correlate well as predictor of alignment loss, although in this study cortical stability seemed more important towards predicting alignment loss.

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Figures

Fig. 1
Fig. 1
1a and 1b Cast index (a/b) at fracture site. Internal cast width on radiograph (a) and internal cast width on AP radiograph (b). Fig. 1c and d Padding index (x/y). Padding thickness in the plane of deformity correction on lateral radiograph (x) and maximum interosseous space on AP radiograph (y).
Fig. 2
Fig. 2
Severity of the fracture defined as a. 1 cortex, b. 2 cortices or c. complete fracture displacement.
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References

    1. Gibbons C.L., Woods D.A., Pailthorpe C., Carr A.J., Worlock P. The management of isolated distal radius fractures in children. J Pediatr Orthop. 1994;14(2):207–210. - PubMed
    1. McLauchlan G.J., Cowan B., Annan I.H., Robb J.E. Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial. J Bone Joint Surg Br. 2002;84(3):413–417. - PubMed
    1. Bohm E.R., Bubbar V., Yong Hing K., Dzus A. Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am. 2006;88(1):1–8. - PubMed
    1. Webb G.R., Galpin R.D., Armstrong D.G. 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(1):9–17. - PubMed
    1. Jordan R.W., Westacott D.J. Displaced paediatric distal radius fractures--when should we use percutaneous wires? Injury. 2012;43(6):908–911. 2012. - PubMed