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Review Question - QID 213984

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QID 213984 (Type "213984" in App Search)
A 5-year-old female patient sustains the fracture shown in Figures A and B. You perform closed reduction and casting. You measure your post-reduction cast index at 0.95. What is the patient at risk for?
  • A
  • B

Increased pain in the affected extremity

1%

16/1631

Growth arrest of the distal radius and ulnar physes

1%

10/1631

Non-union of the fracture

1%

14/1631

Loss of reduction of the fracture

95%

1544/1631

Increased swelling of the affected extremity

3%

41/1631

  • A
  • B

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A cast index greater than 0.8 is a risk factor for loss of reduction of a fracture after casting.

Pediatric both bone forearm fractures can often be treated nonoperatively in a cast. However, there is a risk for displacement. An easy to calculate radiographic measurement to evaluate cast molding is the Cast Index. It is calculated by measuring the inner diameter of a cast on a lateral Xray and divide that by the measured inner diameter of a cast on an AP Xray. This measurement has been shown to be a risk factor for redisplacement of a fracture after reduction and casting when calculated to be greater than 0.8.

McQuinn and Jaarsma assessed risk factors for redisplacement of pediatric both bone forearm fractures after closed reduction and casting. They found that the degree of initial displacement and quality of reduction were significant factors in the risk for redisplacement. When patients had greater than 50% displacement (meaning <50% bony apposition of the fracture), or had less than an anatomic reduction based upon objective radiographic measurements there was an increased risk of redisplacement. Cast index was also evaluated and they found casts with values >0.80 were significantly more likely to redisplace than those <0.80. They conclude that the cast index is a simple measure that should be used in clinical practice.

Kamat et al evaluated 1001 pediatric patients with both bone forearm fractures treated with plaster casting. They found an overall 10.6% redisplacemnt rate. In patients with cast indices ≤0.80 they found a rate of 5.58%, while those with cast indices ≥0.81 redisplaced in 26% of patients (p=0.0001). They conclude by stating the cast index is a simple radiographic measurement and should be the gold standard in the evaluation of proper plaster cast molding.

Figures A and B demonstrate the AP and lateral images of a pediatric distal forearm both bone fracture with dorsal displacement and shortening. Illustration A demonstrates how to measure cast index.

Incorrect answer:
Answer 1-3,5: Cast index has not been shown to affect these outcomes in the casting of pediatric both bone forearm fractures.

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