Cast Index as a Tool for Predicting Re-displacement after Closed Reduction and Cast Immobilization in Forearm Fractures in the Pediatric Age Group

Abstract

Objectives Forearm fractures are very common in all age groups. 81% of forearm fractures happen in children aged above 5 years with the peak of incidence between 9 and 12 years in females and 12 and 15 years in males. In children aged >9 years, remodeling potential is low and re-displacement of fracture after cast application remains a complication (as high as 25%). Quality of casting is an important modifiable risk factor for fracture re-displacement, which can be measured using the Cast index. The purpose of our study was to find out if Cast index should be used as a standard protocol after reduction for assessment of quality of cast. Material and Methods A total number of 40 patients were selected from outpatient department and trauma center based on inclusion and exclusion criteria. These patients were treated with below elbow (B/E) or above elbow (A/E) cast application. Follow-up was done radiologically using the Cast index at 0, 1, and 4 weeks of cast application. Out of 40 patients, 2 patients were remanipulated at one-week follow-up. Results Out of 40 cases of pediatric forearm fracture, 30 (75%) cases were male and 10 (25%) were female. Twenty-seven (67.5%) cases belonged to the 5- to 8-year age group. The mean age was 8.4 ± 2.79 years in males and 6.9 ± 2.23 years in females. The mean Cast index of the whole study was 0.802 ± 0.147 (range 0.48–1.21). The mean Cast index for proximal, middle and distal levels was 0.74, 0.85 and 0.76, respectively. Conclusion Cast index is an excellent marker and gives us an analogy about the quality of cast in pediatric forearm fractures. With proper use, it can also be used as a guiding stick for young orthopedicians. Thus, regular use of Cast index should be encouraged in all orthopedic centers; especially for pediatric forearm fractures.