title: Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?
abstract: BACKGROUND
  Several so-called casting indices are available for objective evaluation of plaster cast quality. The present study sought to investigate four of these indices (gap index, padding index, Canterbury index, and three-point index) as compared to a reference standard (cast index) for evaluation of plaster cast quality after closed reduction of pediatric displaced distal forearm fractures.
  
  
  METHODS
  Forty-three radiographs from patients with displaced distal forearm fractures requiring manipulation were reviewed. Accuracy, sensitivity, specificity, false-positive probability, false-negative probability, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for each of the tested indices.
  
  
  RESULTS
  Comparison among indices revealed diagnostic agreement in only 4.7% of cases. The strongest correlation with the cast index was found for the gap index, with a Spearman correlation coefficient of 0.94. The gap index also displayed the best agreement with the cast index, with both indices yielding the same result in 79.1% of assessments.
  
  
  CONCLUSIONS
  When seeking to assess plaster cast quality, the cast index and gap index should be calculated; if both indices agree, a decision on quality can be made. If the cast and gap indices disagree, the padding index can be calculated as a tiebreaker, and the decision based on the most frequent of the three results. Calculation of the three-point index and Canterbury index appears unnecessary.
authors.affiliation: Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil; Department of Orthopaedics and Trauma, Hospital Santa Teresa, Petrópolis, RJ, Brazil. Electronic address: plabronici@globo.com.
authors.forename: Pedro José
authors.initials: PJ
authors.lastname: Labronici
authors.affiliation: Department of Orthopaedics and Trauma, Hospital Santa Teresa, Petrópolis, RJ, Brazil.
authors.forename: Leonardo Termis
authors.initials: LT
authors.lastname: Ferreira
authors.affiliation: Department of Orthopaedics and Trauma, Hospital Santa Teresa, Petrópolis, RJ, Brazil.
authors.forename: Fernando Claudino
authors.initials: FC
authors.lastname: Dos Santos Filho
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Robinson Esteves Santos
authors.initials: RE
authors.lastname: Pires
authors.affiliation: UFMG, Belo Horizonte, MG, Brazil.
authors.forename: Davi Coutinho Fonseca Fernandes
authors.initials: DC
authors.lastname: Gomes
authors.affiliation: Department of Trauma, Member of Pelvic and Hip Surgery Team, IOT - Hospital do Trauma, Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil.
authors.forename: Luiz Henrique Penteado
authors.initials: LH
authors.lastname: da Silva
authors.affiliation: UFF, Niterói, RJ, Brazil.
authors.forename: Vinicius Schott
authors.initials: VS
authors.lastname: Gameiro
mesh_terms: D000293:Adolescent; D001938:Brazil; D002370:Casts, Surgical / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D005543:Forearm Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D017102:Fracture Healing; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014458:Ulna Fractures / Q000000981:diagnostic imaging* / Q000628:therapy
keywords: Casting indices; Distal forearm fracture; Pediatrics; Prognosis