Abstract
Purpose:
Paediatric forearm fractures are commonly seen and treated by closed reduction and plaster cast application in theatre. Historically, cast application has been subjectively evaluated for its adequacy in maintaining fracture reduction. More recently emphasis has been placed on objectively evaluating the adequacy of cast application using indicators such as the Canterbury index (CI). The CI has been used in predicting post-reduction, re-displacement risk of patients by expressing the casting and padding indices as a ratio.
The CI has been criticized for not including cast 3 point pressure, fracture personality and lack of standardization of X-ray views as well as practical requirement of physical measurement using rulers.
The aim of this study was to determine whether subjective evaluation of these indices, on intra-operative fluoroscopy and the day 1 to 7 postoperative X-ray, was accurate in predicting a patient's ultimate risk of re-displacement, following reduction and casting.
Materials and Methods:
In total, 22 X-rays from 11 patients were evaluated by 20 orthopaedic registrars and 8 consultants, before and after a tutorial on the Canterbury index.
Results:
Formal tutorial did not show an increased subjective predictive accuracy. No clear correlation could be demonstrated between CI and the clinical outcome.
Conclusion:
Value of the CI in clinical practice is doubtful due to various confounding factors. The CI has been used due to lack of other available systems, and ideally a system should be sought which incorporates fracture personality, cast 3 point pressure and standardisation of X-Rays.
