hillingdon cast index.ppt 2
TRANSCRIPT
HILLINGDON CAST INDEX
A QUANTITATIVE AND OBJECTIVE METHOD FOR PREDICTING
THE EFFECTIVENESS OF CAST MOULDING IN THE
MANAGEMENT OF COLLES FRACTURES
A Gupta, S Bassi, D Houlihan Burne, J Dooley, W Bodey
Department of Orthopaedics
Hillingdon Hospital ,Uxbridge, UK
Normal Anatomy
RHRI
VT
Radial Inclination-23 °
Radial Height-12mm
Palmer/Volar Tilt-11 °
Colles Fracture
• Extra-articular fracture of distal end of radius
• 2cm proximal to the articular surface.
• Distal fragment is Dorsally angulated and Dorsally displaced
DINNER FORK DEFORMITY
• Distal fragment is Supinated and Radially displaced.
• There is shortening at the fracture site.
RH
Closed ReductionCReduction
Moulding
Manipulation
Closed Reduction
Analysis Of Cast Application
• Closed Reduction and Manipulation
Volar Tilt
Radial Shortening
Radial Inclination
• Moulding
No method described
“HILLINGDON CAST INDEX”
Hillingdon Cast Index
• Aim-
To determine an index that allows quantitative and objective assessment of the adequacy of cast moulding in the management of colles’ fractures.
(Maximum transverse dimension of the cast at fracture site in Lateral view)
(Maximum transverse dimension of the cast at fracture site in PA view)
Hillingdon Cast Index
PA
HCI-LAT/PA
LAT
U
R
POSTERIOR
ANTERIOR
LAT
AP
Hillingdon Cast Index
URR U
MOULDED PLASTER
HCI – 0.74
PLASTER WITHOUT MOULDING
HCI – 1.1
P
A
Materials & Methods
Radiological Review Of Extra-articular Fractures Of Distal End Of Radius
• Exclusion Criteria for the cohort group Age - <20 years and > 60 years AO Classification- B and C –Intra-articular fractures Fracture Patterns that were not reduced to an acceptable value- * Loss of Volar Tilt >10° Radial Shortening->2mm Change in Radial Inclination -5 °
* Fractures of the Distal Aspect of the Radius: Changes in treatment over the past two decades-
Paul M Simic ,Andrew J Weiland .JBJS(Am)2003,85 –A,552-565
Material and Methods• Total No of Radiographs 412 cases of distal radius fractures over a 4 year period
Radiographs satisfying our criteria- 183
Group I - the fracture united without operative intervention Group II -required operative intervention due to displacement of the fragments
I – 61 (34%) II –122 (66%)
• Age - 20 -60 yrs* • Period of Study - 4 years
*Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists.
Mc Queen MM, Acta Orthop Scand.2003 Feb;74(1):98-100
Data AnalysisGroup I – Patients managed without operative intervention
HCI - 0.78 (0.66 - 0.85)
00.1
0.20.3
0.40.50.6
0.70.8
0.91
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61
PATIENTS
HC
I
Data Analysis
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1 9 17 25 33 41 49 57 65 73 81 89 97 105 113 121
PATIENTS
HC
I
Group II – Patients managed with operative intervention
HCI-0.94( 0.74-0.1.3)
Data Analysis
GROUP I GROUP II
29
18
28
28
28
29
1518
8
36
56
22
0
10
20
30
40
50
60
0.65-0.70 0.7-0.75 0.76-0.80 0.81-0.85 0.86-0.90 0.91-0.95 0.96-1.0
Data Analysis
• Statistics-
• Assessed with the Chi-Square Test X-ray with- • HCI > 0.96 has a 90% chance that the fracture will displace.
(P value<0.001)
• HCI <0.72 has a 84% chance that the fracture will not displace. (P value<0.05)
HCI-0.76
HCI-0.74
PALAT
HCI-1.1
HCI-0.94
Conclusion
We recommend specific teaching in the manipulation and plaster cast application on a regular basis to prevent
redisplacement of the fracture fragments.
“Contrary to the popular ideas, the operative treatment of fractures is much simpler than is the non-operative.
The young surgeon needs to be well trained in this difficult and demanding field from the earliest moment”
Sir John Charnley