Ali TURGUT, Serkan ERKUŞ, Anıl KOCA, Levent PAYZINER, Ali Osman ÇİÇEK, Önder KALENDERER

Analysis of the factors causing tight cast syndrome after closed reduction and casting of pediatric distal radius fractures

Objective: The aim of this study was to evaluate the most important factors which can cause “tight castsyndrome’’ (TCS) in pediatric patients with distal radius fractures.Methods: Patients, who were at or under 15 years old and treated conservatively with an diagnosis ofdistal radius fracture between August 2015 and August 2017 were included in to the study. Fifty fourpatients, who had been found to experience TCS were accepted as group 1 and sixty-two patientswithout TCS as group 2. Cast index, pre-/post reduction translation, pre-/post reduction angulation,localization and displacement of the fracture, need for re-manipulation, and presence of associated distalulna fracture were evaluated for both groups. Statistical analysis was performed to evaluate cut off valuefor cast index values for both TCS and loss of reduction and logistic regression analysis of the otherpossible factors.Results: Pre-/post-reduction translation (over 50% and 10%, respectively) (odds ratios:0.167 and 0.524,respectively), a cast index value below than 0.775 (odds ratio:3.080), displaced type fracture (odds ratio:8.028),presence of re-manipulation (odds ratio:0.131) and associated distal ulna fracture (odds ratio:2.029)were found to be statistically significantly important for the occurrence of TCS. The mostimportant factors were decreased cast index value and presence of initially displaced type fracture. Lossof reduction (LOR) risk was found to be increased in patients with a cast index value of greater than0.875.Conclusion: One should be very careful when following a pediatric patient who have a displaced distalradius fracture which has initial/post reduction translation in AP plane, which is associated with distalulna fracture, which required re-manipulation and most importantly which cast index is under than0.775 in terms of occurrence of TCS. We recommend obtaining a cast index value between 0.775 and0.875 to prevent both TCS and LOR.

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