Importance of calculating various casting indices in predicting radiological outcomes of paediatric forearm fractures

Pyntngen Kharbamon, Binoti A. Sheth, Pankaj Pawar, Siddhart Parekh, Rishabh Jaiswal, Umesh Kanade


Background: The present study is aimed at determining the importance of various casting indices in predicting the outcome of paediatric forearm fractures treated with closed reduction and plaster application in our department.

Methods: Thirty children, aged 5 to 15 years, with closed forearm fractures not requiring surgical fixation were included to assess their casting indices and radiological outcomes using X-rays. After satisfactory casting, patients were followed up weekly till 6 weeks with anteroposterior (AP) and lateral X-ray.

Results: Acceptable reduction was achieved in 26 cases, while re-manipulation was done in 4 cases. Cast Index ranged from 0.80±0.09 at first week to 0.78±0.09 at 6 weeks, Padding Index was 0.30±0.04 at first week and increased to 0.31±0.03 at 6 weeks, Canterbury Index was 1.07±0.24 at first week and 1.07±0.78 at 6 weeks, Gap Index 0.15±0.02 remained the same throughout, and Three Point Index changed from 0.81±0.08 at first week to 0.77±0.18 six weeks. Radial bow of children showed no significant change at various time points of assessment. Rotational mal-alignment was observed in 5 patients, one had a 0.5 cm radial overlap, while none had an ulnar overlap. Radial angulation was observed in five and six children on AP and lateral X-ray respectively. Ulnar angulation was seen in two and one child on AP and lateral X-ray respectively.

Conclusions: Continued use of these casting indices to assess paediatric forearm cast adequacy is supported by this study.


Casting indices, Paediatric forearm fracture, Prognosis

Full Text:



Landin LA. Epidemiology of children's fractures. J Pediatr Orthop B. 1997;6:79-83.

Devalia KL, Asaad SS, Kakkar R. Risk of redisplacement after first successful reduction in paediatric distal radius fractures: sensitivity assessment of casting indices. J Pediatr Orthop B. 2011;20:376–81.

Zamzam MM, Khoshhal KI. Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction. J Bone Joint Surg Br. 2005;87:841–3.

Charnley J. The closed treatment of common fractures. Baltimore: Williams and Wilkins; 1968.

Chess D, Hyndman J, Leahey J, Brown D, Sinclair A. Short Arm Plaster Cast for Distal Paediatric Forearm Fractures. J Paedi Orthop. 1994;14(2):211-3.

Bhatia M, Housden P. Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding. Injury. 2006;37(3):259-68.

Malviya A, Tsintzas D, Bache C, Gibbons P, Glithero P. Gap index-A good predictor of failure of plaster cast in distal forearm fractures. Injury Extra. 2007;38(1):11-12.

Alemdaroğlu K, İltar S, Aydoğan N, Say F, Kılınç C, Tiftikçi U. Three-point index in predicting redisplacement of extra-articular distal radial fractures in adults. Injury. 2010;41(2):197-203.

Bohm ER, Bubbar V, Yong-Hing K, Dzus A. Above and below-the-elbow plaster casts for distal forearm fractures in children: a randomized controlled trial. JBJS. 2006;88(1):1-8.

Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am. 2006;88:9–17.

Sheikh HQ, Malhotra K, Wright P. Cast index in predicting outcome of proximal pediatric forearm fractures. Indian journal of orthopaedics. 2015;49(4):398.

Kamat AS, Pierse N, Devane P, Jonathan Mutimer J, Horne G, et al. Redefining the Cast Index: The Optimum Technique to Reduce Redisplacement in Pediatric Distal Forearm Fractures. J Pediatr Orthop. 2012;32:787–91.

Labronici PJ, Ferreira LT, dos Santos Filho FC, Pires RE, Gomes DC, da Silva LH, et al. Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?. Injury. 2017;48(2):552-6.