Cast and padding indices used for clinical decision making in forearm fractures in children

PURPOSE: We assessed the reliability and practicality of two radiographic measurements--cast index and padding index--of the quality of plaster cast in clinical decision making in forearm fractures in children.

METHODS: 40 orthopedic surgeons (20 consultants and 20 registrars) were asked to predict the risk of re-displacement in 5 randomly selected cases. Subsequently, these surgeons were taught these indices and they were then requested to use them to predict re-displacement.

RESULTS: Every one of the 40 surgeons showed an increase in the number of correct responses. For consultants, the accuracy improved from 33% to 72% and for the registrars it improved from 28% to 81%. This improvement was statistically significant.

INTERPRETATION: We suggest that cast and padding indices are simple, reliable, and reproducible radio-graphic tools that can be used in clinics and wards to predict re-displacement of forearm fractures in children following initial reduction.