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Three-Point Index Can Predict Redisplacement of Radial Fractures in Children
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Posted on: 11/30/1999
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One of the most common fractures among children is the radial fracture, that of the forearm. Luckily, the arms usually heal well and rarely cause problems, unlike adult fractures of the same bone. However, sometimes, conservative treatment, casting, isn't always enough to heal the fracture, resulting in displacement, healing that isn't straight or uniform.
The reasons for this problem include the fracture not being placed properly before casting, a complete break of the bone, break of the nearby bone, the ulna, the cast not being effective, surgeon inexperience, and even the type of anesthetic used during surgery.
The authors of this study investigated their new index for measuring if treatment would be successful or not, using a three-point system.
Researchers enrolled 74 children with radial fractures, three did not complete the study. They were all under 15 years old and were treated with a cast within 24 hours of the break. Initially, all children had a closed reduction of the break, meaning that the physician in the emergency room set the break without surgery, and the arms were then casted. The patients were given some sedatives to make the procedure more tolerable.
The thickness of the padding in the cast, the molding and the positioning of the wrist were all noted. The patients were then followed every week for four weeks to check for any movement in the fracture. As a result, five patients had their arm recasted twice and one had it done three times. The follow-ups included checking for blood circulation in the arm and hand 24 hours after the casts were applied. Three patients had their casts split because of circulation problems and then recasted.
For this study, the three-point index resulted from a calculation of fracture gap, angle and contact between the fracture fragments. At the end of the study, there were 19 fracture displacement in 17 patients and only six needed to be remanipulated. Of the 19, 17 were found within the first week after the break. When using this index, the researchers were able to predict quite well which patients were likely to have problems. The authors do point out however, that their study had limitations: they were not able to use different types of sedation and the long-arm versus short-arm casts weren't compared, for example.
The authors conclude that their three-point index is a reliable method of predicting how a radial fracture will react, with the complete break and the increased angle of the break being the most important of the three indicators.
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References:
Kadir Bahadir Alemaroglu, MD, et al. Risk Factors in Redisplacement of Distal Radial Fractures in Children. In The Journal of Bone and Joint Surgery. June 2008. Vol. 30. No. Pp. 1224-1230.
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