Cargando…

Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle

PURPOSE: Recent literature comparing the effectiveness of above-elbow and below-elbow plaster casts appears to suggest that either cast type offers adequate immobilization for distal radius and ulna fractures. The idea that an appropriate mold placed on the cast is the most significant determinant o...

Descripción completa

Detalles Bibliográficos
Autores principales: Edmonds, Eric W., Capelo, Roderick M., Stearns, Philip, Bastrom, Tracey P., Wallace, C. Douglas, Newton, Peter O.
Formato: Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758178/
https://www.ncbi.nlm.nih.gov/pubmed/19701659
http://dx.doi.org/10.1007/s11832-009-0198-1
_version_ 1782172572637462528
author Edmonds, Eric W.
Capelo, Roderick M.
Stearns, Philip
Bastrom, Tracey P.
Wallace, C. Douglas
Newton, Peter O.
author_facet Edmonds, Eric W.
Capelo, Roderick M.
Stearns, Philip
Bastrom, Tracey P.
Wallace, C. Douglas
Newton, Peter O.
author_sort Edmonds, Eric W.
collection PubMed
description PURPOSE: Recent literature comparing the effectiveness of above-elbow and below-elbow plaster casts appears to suggest that either cast type offers adequate immobilization for distal radius and ulna fractures. The idea that an appropriate mold placed on the cast is the most significant determinant of successful immobilization and, thereby, patient outcome has also been elucidated. The purpose of this study was to compare the effectiveness of above-elbow versus below-elbow fiberglass casts in maintaining distal radius/ulna fracture reduction and to identify factors associated with treatment failures. METHODS: We reviewed the radiographs and clinical data of 253 children with distal third forearm fractures requiring reduction under conscious sedation or a hematoma block. Outcome measures included rates of re-manipulation, loss of reduction, and cast complications. RESULTS: One hundred and nineteen children were treated with below-elbow fiberglass casts and 134 were treated with above-elbow fiberglass casts based on a clinical pathway created before the study period. There were no differences between the two groups in age, weight, fracture pattern, percentage of both-bone fractures, and initial fracture angulation. Of the 253 fractures in the study, 38 (15%) were considered to have less than ideal outcomes. There were no differences between the ‘ideal’ and ‘non-ideal’ groups in age, fracture pattern, presence of ulna fracture, cast index, or cast type. All immediate post-reduction measures (anterior-posterior [AP] and lateral displacement/angulation) were significantly correlated with treatment outcome, except angulation on AP films. The magnitude of reduction as measured by a newly described variable, the angle between the second metacarpal and long axis of the radius in the AP projection, was significantly correlated with treatment failure (r = −0.139, P = 0.027). Binary logistic regression was performed and demonstrated that the success of the reduction, as determined by the AP radiograph second metacarpal-radius angle, was a significant predictor of treatment success (odds ratio 1.6, P < 0.001). Also, the change in lateral view angulation post-reduction was a significant predictor of treatment failure based on regression (odds ratio 1.2, P = 0.004). The above-elbow cast group had a slightly greater cast index (0.80) compared to the below-elbow cast group (0.77) (P = 0.003). Whereas below-elbow fiberglass casts appear to be equally effective in immobilizing pediatric distal third forearm fractures as above-elbow fiberglass casts, it seems that they have an increased risk for poor molding, particularly with regards to ulnar deviation. We did not find an association between the treatment ‘failure’ and cast index, likely because the number of poor molds (cast index >0.8) was nearly equal in each group (above-elbow with 61 and below-elbow with 45). However, the mold seen on the AP radiograph as determined by the second metacarpal-radius angle was a reproducible radiographic predictor of treatment success. If molded with ulnar deviation (second metacarpal-radius angle >0°), the outcome was considered to be ideal in 86.7% of cases compared to only 74.4% when it was <0°. CONCLUSION: We agree with prior studies suggesting the equal efficacy of below-elbow versus above-elbow casts in distal radius and ulna fracture treatment using either plaster or fiberglass, but wish to emphasize the importance of not only the cast index, but also the ulnar deviation mold (for most dorsally displaced fractures), as measured by the second metacarpal-radius angle.
format Text
id pubmed-2758178
institution National Center for Biotechnology Information
language English
publishDate 2009
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-27581782009-10-07 Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle Edmonds, Eric W. Capelo, Roderick M. Stearns, Philip Bastrom, Tracey P. Wallace, C. Douglas Newton, Peter O. J Child Orthop Original Clinical Article PURPOSE: Recent literature comparing the effectiveness of above-elbow and below-elbow plaster casts appears to suggest that either cast type offers adequate immobilization for distal radius and ulna fractures. The idea that an appropriate mold placed on the cast is the most significant determinant of successful immobilization and, thereby, patient outcome has also been elucidated. The purpose of this study was to compare the effectiveness of above-elbow versus below-elbow fiberglass casts in maintaining distal radius/ulna fracture reduction and to identify factors associated with treatment failures. METHODS: We reviewed the radiographs and clinical data of 253 children with distal third forearm fractures requiring reduction under conscious sedation or a hematoma block. Outcome measures included rates of re-manipulation, loss of reduction, and cast complications. RESULTS: One hundred and nineteen children were treated with below-elbow fiberglass casts and 134 were treated with above-elbow fiberglass casts based on a clinical pathway created before the study period. There were no differences between the two groups in age, weight, fracture pattern, percentage of both-bone fractures, and initial fracture angulation. Of the 253 fractures in the study, 38 (15%) were considered to have less than ideal outcomes. There were no differences between the ‘ideal’ and ‘non-ideal’ groups in age, fracture pattern, presence of ulna fracture, cast index, or cast type. All immediate post-reduction measures (anterior-posterior [AP] and lateral displacement/angulation) were significantly correlated with treatment outcome, except angulation on AP films. The magnitude of reduction as measured by a newly described variable, the angle between the second metacarpal and long axis of the radius in the AP projection, was significantly correlated with treatment failure (r = −0.139, P = 0.027). Binary logistic regression was performed and demonstrated that the success of the reduction, as determined by the AP radiograph second metacarpal-radius angle, was a significant predictor of treatment success (odds ratio 1.6, P < 0.001). Also, the change in lateral view angulation post-reduction was a significant predictor of treatment failure based on regression (odds ratio 1.2, P = 0.004). The above-elbow cast group had a slightly greater cast index (0.80) compared to the below-elbow cast group (0.77) (P = 0.003). Whereas below-elbow fiberglass casts appear to be equally effective in immobilizing pediatric distal third forearm fractures as above-elbow fiberglass casts, it seems that they have an increased risk for poor molding, particularly with regards to ulnar deviation. We did not find an association between the treatment ‘failure’ and cast index, likely because the number of poor molds (cast index >0.8) was nearly equal in each group (above-elbow with 61 and below-elbow with 45). However, the mold seen on the AP radiograph as determined by the second metacarpal-radius angle was a reproducible radiographic predictor of treatment success. If molded with ulnar deviation (second metacarpal-radius angle >0°), the outcome was considered to be ideal in 86.7% of cases compared to only 74.4% when it was <0°. CONCLUSION: We agree with prior studies suggesting the equal efficacy of below-elbow versus above-elbow casts in distal radius and ulna fracture treatment using either plaster or fiberglass, but wish to emphasize the importance of not only the cast index, but also the ulnar deviation mold (for most dorsally displaced fractures), as measured by the second metacarpal-radius angle. Springer Berlin Heidelberg 2009-08-22 2009-10 /pmc/articles/PMC2758178/ /pubmed/19701659 http://dx.doi.org/10.1007/s11832-009-0198-1 Text en © The Author(s) 2009 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Original Clinical Article
Edmonds, Eric W.
Capelo, Roderick M.
Stearns, Philip
Bastrom, Tracey P.
Wallace, C. Douglas
Newton, Peter O.
Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
title Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
title_full Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
title_fullStr Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
title_full_unstemmed Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
title_short Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
title_sort predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758178/
https://www.ncbi.nlm.nih.gov/pubmed/19701659
http://dx.doi.org/10.1007/s11832-009-0198-1
work_keys_str_mv AT edmondsericw predictinginitialtreatmentfailureoffiberglasscastsinpediatricdistalradiusfracturesutilityofthesecondmetacarpalradiusangle
AT capeloroderickm predictinginitialtreatmentfailureoffiberglasscastsinpediatricdistalradiusfracturesutilityofthesecondmetacarpalradiusangle
AT stearnsphilip predictinginitialtreatmentfailureoffiberglasscastsinpediatricdistalradiusfracturesutilityofthesecondmetacarpalradiusangle
AT bastromtraceyp predictinginitialtreatmentfailureoffiberglasscastsinpediatricdistalradiusfracturesutilityofthesecondmetacarpalradiusangle
AT wallacecdouglas predictinginitialtreatmentfailureoffiberglasscastsinpediatricdistalradiusfracturesutilityofthesecondmetacarpalradiusangle
AT newtonpetero predictinginitialtreatmentfailureoffiberglasscastsinpediatricdistalradiusfracturesutilityofthesecondmetacarpalradiusangle