Session VI - Pediatrics / Spine

Fri., 10/11/13 Pediatrics/Spine, PAPER #73, 4:30 pm OTA 2013

Predicting Redisplacements of Diaphyseal Forearm Fractures: How About the Three-Point Index?

Serkan Iltar; Kadir Bahadir Alemdaroglu, MD; Ferhat Say; Nevres H. Aydogan;
Ankara Training and Research Hospital, Ankara, Turkey

Background/Purpose: Redisplacement is the most common complication during the cast treatment of forearm diaphyseal fractures in children. It would seem to be worth making an effort to apply the three-point index (TPI) to diaphyseal forearm fractures, as it has previously been found to most accurately predict redisplacement in the distal radius. The index is based on the three-point fixation principle in the cast treatment. The aim of this prospective study was to determine the effect of cast-related indices and other factors that could play a role in redisplacement.

Methods: 76 children were included. Age, initial complete displacement, reduction quality, location of the fracture, having fractures at different levels, and quality of the casting (according to TPI, cast index, Canterbury index, padding index) of each patient were analyzed as possible risk factors. Logistic regression analysis was utilized to search for risk factors.

Results: A total of 18 of 76 fractures were redisplaced in the cast. A TPI value higher than 0.8 was the only significant risk factor for redisplacement at 239 times more likely to redisplace (P <0.001; odds ratio: 238.5; 95% confidence interval: 7.063-8054.86) than those with lower values. The TPI was far superior to other cast-related indices with a sensitivity of 84% and a specificity of 97%.

Conclusion: A cast lacking adequate three-point fixation is the major risk factor for a forthcoming redisplacement of a diaphyseal forearm fracture of the children.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.