title: Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices.
abstract: Background and purpose - Manipulation and cast immobilization is the primary management for diaphyseal forearm fractures in children, and re-displacement is the most common complication. We wanted (1) to analyze the incidence of re-displacement in a group of children treated with close reduction and casting; (2) to determine predictive factors such as demographics, mechanism of injury, affected bone, fracture pattern, degree of initial displacement and angulation, and reduction accuracy; and (3) to determine the prognostic effect of previously defined radiographic indices. Patients and methods - We prospectively studied 269 consecutive children with closed and complete middle-third diaphyseal fractures treated with close reduction and casting from October 2014 to April 2015. Factors analyzed included demographics, initial fracture features, having a non-anatomical reduction, and the radiographic indices of cast quality. Results - There were 189 fractures of both bones (70%) and 80 solitary fractures (30%). The overall re-displacement rate was 11%. According to multivariable analysis, independent predictors of re-displacement were initial angulation >10° (RR =5) and failure to achieve an anatomical reduction (RR =2). Statistically significant radiographic indices regarding increased rate of re-displacement included cast index ≥0.7 (RR =5), Canterbury index ≥1.1 (RR =3), and 3-point index ≥0.8 (RR =6). Interpretation - Our results suggested that fractures with a higher degree of initial angulation and non-anatomical reduction more often result in re-displacement. Moreover, the casting quality examined with the radiographic indices played an important role in the success of a non-operative management.
authors.affiliation: a School of Medicine and Student Research Committee , Shahid Beheshti University of Medical Sciences.
authors.forename: Shadi
authors.initials: S
authors.lastname: Asadollahi
authors.affiliation: b Department of Emergency Medicine , Loghmane-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Pourali
authors.affiliation: b Department of Emergency Medicine , Loghmane-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Heidari
mesh_terms: D002370:Casts, Surgical; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography / Q000379:methods*; D011885:Radius Fractures / Q000175:diagnosis* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014458:Ulna Fractures / Q000175:diagnosis* / Q000628:therapy