Factors responsible for redisplacement of pediatric forearm fractures treated by closed reduction and cast: Role of casting indices and three point index

Background: The present study is aimed at determining the importance of various casting indices in predicting the outcome of paediatric forearm fractures treated with closed reduction and plaster application in our department.Methods: Thirty children, aged 5 to 15 years, with closed forearm fractures not requiring surgical fixation were included to assess their casting indices and radiological outcomes using X-rays. After satisfactory casting, patients were followed up weekly till 6 weeks with anteroposterior (AP) and lateral X-ray.Results: Acceptable reduction was achieved in 26 cases, while re-manipulation was done in 4 cases. Cast Index ranged from 0.80±0.09 at first week to 0.78±0.09 at 6 weeks, Padding Index was 0.30±0.04 at first week and increased to 0.31±0.03 at 6 weeks, Canterbury Index was 1.07±0.24 at first week and 1.07±0.78 at 6 weeks, Gap Index 0.15±0.02 remained the same throughout, and Three Point Index changed from 0.81±0.08 at first week to 0.77±0.18 six weeks. Radial bow of children showed no significant change at various time points of assessment. Rotational mal-alignment was observed in 5 patients, one had a 0.5 cm radial overlap, while none had an ulnar overlap. Radial angulation was observed in five and six children on AP and lateral X-ray respectively. Ulnar angulation was seen in two and one child on AP and lateral X-ray respectively.Conclusions: Continued use of these casting indices to assess paediatric forearm cast adequacy is supported by this study.

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Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70049-x ◽

2007 ◽

Vol 2007 ◽

pp. 46-47

Author(s):

H.A. Peterson

Keyword(s):

Forearm Fractures

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The potential role of the Alsberg angle as a predictor of lateral growth disturbance of the capital femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190158 ◽

2020 ◽

Vol 14 (2) ◽

pp. 106-111 ◽

Cited By ~ 1

Author(s):

Ronghua Gui ◽

Federico Canavese ◽

Shuang Liu ◽

Lianyong Li ◽

Lijun Zhang ◽

...

Keyword(s):

Closed Reduction ◽

Normal Values ◽

Developmental Dysplasia ◽

Lateral Growth ◽

Growth Disturbance ◽

Level Of Evidence ◽

Normal Children ◽

One Year ◽

Dysplasia Of The Hip

Purpose Early diagnosis and prevention of lateral growth disturbance of the capital femoral epiphysis is challenging after treatment for developmental dysplasia of the hip (DDH). The aim of the study was to evaluate the radiographic changes of the Alsberg angle (AA) in normal children and those with DDH, and to assess the role of AA as a potential predictor of lateral growth disturbance of the capital femoral epiphysis. Methods AA was measured on the anterior-posterior pelvic radiographs of 1000 normal children ranging in age from one to ten years and in 66 children (92 hips) with DDH treated by closed reduction (CR). A comparative analysis was performed. Results In the normal children, mean AA decreased linearly with age, from 76° at age one year to 65° at age ten years, irrespective of gender and laterality. In children with DDH, the average AA was 81.5°(sd 3.9°; 74° to 87°) prior to CR; it was 75.9° (sd 4.5°; 68° to 83°) in normal children of the same age (p < 0.001). Among the 42 children (64 hips) with successfully and uneventfully treated DDH, AA reached normal values between the ages of five and six years. In contrast, children with lateral growth disturbance of the proximal femur physis (24 children, 28 hips) showed significantly higher AA values in comparison with the age-matched controls. Conclusion In DDH patients with successful CR, AA could be expected to match normal values in children between the ages of five and six years. On the other hand, AA can be used as an early predictor for lateral growth disturbance of the capital femoral epiphysis. Level of Evidence Level III

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Can intraoperative ultrasound visualize the closed reduction and elastic intramedullary nail fixation processes of double forearm fractures in children?

Medicine ◽

10.1097/md.0000000000024324 ◽

2021 ◽

Vol 100 (12) ◽

pp. e24324

Author(s):

Xiaodong Yang ◽

Lang Li ◽

Xueyang Tang ◽

Bo Xiang ◽

Tianfu Wen

Keyword(s):

Intramedullary Nail ◽

Closed Reduction ◽

Intraoperative Ultrasound ◽

Forearm Fractures ◽

Fractures In Children

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Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Medicina ◽

10.3390/medicina56020079 ◽

2020 ◽

Vol 56 (2) ◽

pp. 79

Author(s):

Ovidiu Adam ◽

Vlad Laurentiu David ◽

Florin George Horhat ◽

Eugen Sorin Boia

Keyword(s):

Closed Reduction ◽

Diagnosis Related Groups ◽

Financial Burden ◽

Treatment Options ◽

Indirect Costs ◽

Forearm Fractures ◽

Titanium Elastic Nail ◽

Fractures In Children ◽

Elastic Nail ◽

The Cost

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

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