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The role of periosteum and the position of immobilisation cannot be ignored
Injury, Int. J. Care Injured (2007) 38, 1326—1331
www.elsevier.com/locate/injury
LETTER TO THE EDITOR The role of periosteum and the position of immobilisation cannot be ignored
*Tel.: +44 794 030 9119 E-mail address: [email protected]
Sir, doi:10.1016/j.injury.2007.01.018
This article1 has been read with great interest. The authors have made a very good effort in assessing a very common concern in our clinical practice. I would like to clarify a few points with the authors based on their findings: 1. In your clinical practice post operatively following a manipulation and cast application with good reduction, if the combined Canterbury index is more than 1.1 would you remove and reapply the cast as the chances for displacement are more as shown in your study. 2. In children with good reduction and a low Canterbury index would you avoid a clinic review within a week to check for displacement? Multiple clinic appointments have been shown to affect the parents work timings and cause loss of earnings. 3. The authors have not considered the role of the periosteum3 which plays an important role in paediatric fractures and no mention has been made about their experience on the effect of the position of immobilisation2 in the redisplacement of the fractures.
References 1. Bhatia M, Housden PH. Redisplacement of paediatric forearm fractures: role of plaster moulding and padding. Injury 2006;37(March (3)):259—68. 2. Boyer BA, Overton B, Schrader W, et al. Position of immobilisation for pediatric forearm. J Pediatr Orthop 2002;22(March— April (2)):185—7. 3. Lindaman LM. Bone healing in children. Clin Podiatr Med Surg 2001;18(January (1)):97—108.
Suresh Thomas* Department of Orthopaedics, North Tyneside Hospital, Rake Lane, North Shields, Tyne and Wear NE30 4EB, United Kingdom
AUTHOR’S REPLY Role of plaster moulding and padding. Redisplacement of Paediatric forearm fractures Many thanks for your interest in this article. 1. In practice, imperfect reduction and poor cast moulding go together and it is rare to see anatomic reduction and poor moulding. Indeed if we see a case of less than perfect reduction and poor cast moulding we act pre-emptively and remanipulate and re-plaster. 2. All the cases that had a manipulation in theatre for a displaced fracture are seen at least once in a week’s time. As we mentioned in our paper, severity of initial displacement is a confounding variable for redisplacement and cases that had initial displacement greater than 50% are at risk of redisplacement and must have a check radiograph at one week. 3. As regards to the role of periosteum, as previously mentioned initial displacement of fracture is a key risk factor for redisplacement and in these cases the periosteum would be stripped off making the fracture unstable. As regards to the position of immobilisation, in our experience this has no role to play in redisplacement. There is good evidence in the literature that distal third forearm fractures can be treated in short arm casts.
DOI of original article: 10.1016/j.injury.2007.01.018.
0020–1383/$ — see front matter # 2007 Elsevier Ltd. All rights reserved.
www.elsevier.com/locate/injury
LETTER TO THE EDITOR The role of periosteum and the position of immobilisation cannot be ignored
*Tel.: +44 794 030 9119 E-mail address: [email protected]
Sir, doi:10.1016/j.injury.2007.01.018
This article1 has been read with great interest. The authors have made a very good effort in assessing a very common concern in our clinical practice. I would like to clarify a few points with the authors based on their findings: 1. In your clinical practice post operatively following a manipulation and cast application with good reduction, if the combined Canterbury index is more than 1.1 would you remove and reapply the cast as the chances for displacement are more as shown in your study. 2. In children with good reduction and a low Canterbury index would you avoid a clinic review within a week to check for displacement? Multiple clinic appointments have been shown to affect the parents work timings and cause loss of earnings. 3. The authors have not considered the role of the periosteum3 which plays an important role in paediatric fractures and no mention has been made about their experience on the effect of the position of immobilisation2 in the redisplacement of the fractures.
References 1. Bhatia M, Housden PH. Redisplacement of paediatric forearm fractures: role of plaster moulding and padding. Injury 2006;37(March (3)):259—68. 2. Boyer BA, Overton B, Schrader W, et al. Position of immobilisation for pediatric forearm. J Pediatr Orthop 2002;22(March— April (2)):185—7. 3. Lindaman LM. Bone healing in children. Clin Podiatr Med Surg 2001;18(January (1)):97—108.
Suresh Thomas* Department of Orthopaedics, North Tyneside Hospital, Rake Lane, North Shields, Tyne and Wear NE30 4EB, United Kingdom
AUTHOR’S REPLY Role of plaster moulding and padding. Redisplacement of Paediatric forearm fractures Many thanks for your interest in this article. 1. In practice, imperfect reduction and poor cast moulding go together and it is rare to see anatomic reduction and poor moulding. Indeed if we see a case of less than perfect reduction and poor cast moulding we act pre-emptively and remanipulate and re-plaster. 2. All the cases that had a manipulation in theatre for a displaced fracture are seen at least once in a week’s time. As we mentioned in our paper, severity of initial displacement is a confounding variable for redisplacement and cases that had initial displacement greater than 50% are at risk of redisplacement and must have a check radiograph at one week. 3. As regards to the role of periosteum, as previously mentioned initial displacement of fracture is a key risk factor for redisplacement and in these cases the periosteum would be stripped off making the fracture unstable. As regards to the position of immobilisation, in our experience this has no role to play in redisplacement. There is good evidence in the literature that distal third forearm fractures can be treated in short arm casts.
DOI of original article: 10.1016/j.injury.2007.01.018.
0020–1383/$ — see front matter # 2007 Elsevier Ltd. All rights reserved.