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Investigating The Presence Of A Radial Bubble As A Cast Index To Predict Re-displacement Following Closed Reduction Of Distal Forearm Fractures In Children
Bryn Gornick1, Jonathan Semaan2, Matthew Weber3, John Schlechter4
1CHOC Children's Hospital, Orange, CA;2Western University of Health Sciences, Pomona, CA;3Riverside University Health System, Riverside, CA;4Pediatric Orthopedic Specialists of Orange County, Orange, CA

BACKGROUND - Various cast indices have been reported to predict re-displacement following closed reduction of pediatric forearm fractures. This study defines and examines whether the presence of a “radial bubble” (RB) in a pediatric forearm cast predicts re-displacement in distal forearm fractures following closed reduction.
METHODS - Children who sustained a closed distal radius fracture with or without a concomitant ulna fracture treated with closed reduction and casting were retrospectively identified. RB was defined radiographically. RB was present if the A/C ratio was greater than 1 and the A/B ratio was greater than 1.5 (Figure). Demographics, cast indices, and fracture position were recorded. Inter and intra-observer reliability to detect a RB was measured for attending and resident physicians. Statistical analysis was performed.

RESULTS - 63 children with an average age of 7.1 years (1.1-10.0 years) were identified. Re-displacement occurred in 15 children (24%). No correlation was found between RB and re-displacement (p=0.663). Intra observer reliability was moderate to substantial for the measurement of a RB for the attending (kappa= 0.572) and resident (kappa= 0.661) respectively. Inter observer reliability was fair to moderate (kappa= 0.305 and 0.505). There was no correlation found between cast index (p=0.923), gap index (p=0.349), Canterbury index (p=0.923), and 2nd metacarpal-distal radius angle (p=0.617) with re-displacement.
CONCLUSIONS - Although radiographically unsightly, radial bubbles in pediatric forearm casts did not predict re-displacement.


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