{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T12:32:05Z","timestamp":1764333125089,"version":"3.41.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>The objective of this study was to assess whether the positioning of the wrist joint in the cast in such a manner that it counteracts the direction of angulation of fragments is more important than the cast index in the prevention of secondary displacements in distal forearm fractures. A retrospective review of all pediatric patients (0\u201316 years of age) who were hospitalized in our institution with displaced fractures of the distal forearm (either isolated fractures of the distal radius or both bone fractures) who underwent subsequent closed reduction and splinting in the period from August 2018 to October 2020. Patients with physeal fractures and open fractures, and skeletally mature patients were excluded from the study. Patients were divided into two categories \u2013 the first one in which the cast index was below 0.9 and the second in which it was above 0.9. In each category, we have identified two groups of patients \u2013 the first one in whom the wrist joint was positioned in such a manner that it counteracts the direction of angulation of fracture fragments and the second one in whom the wrist joint was in a neutral position. The two groups in each category have been compared according to age, sex, initial angulation, fracture type (isolated radius or both bone fractures), displacement type (angulation or complete dislocation) and the rate of secondary displacement. In both categories, the two groups were comparable according to age, sex, initial angulation, fracture and displacement type. In both categories (cast index below 0.9 and cast index above 0.9), a statistically significant higher portion of patients with secondary displacement was identified in the group of patients who had the wrist joint in a neutral position (<jats:italic toggle=\"yes\">Z<\/jats:italic> = \u22122.1997; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.0278 \u2013 for cast index &lt;0.9 and <jats:italic toggle=\"yes\">Z<\/jats:italic> = \u22122.1672; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.030216 for cast index &gt;0.9). Our research supports the notion that positioning of the wrist joint in the position that counteracts the force that leads to angulation of fracture fragments is more important than the cast index in the prevention of secondary displacements in pediatric distal forearm fractures.<\/jats:p>","DOI":"10.1097\/bpb.0000000000000976","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T14:00:52Z","timestamp":1649772052000},"page":"145-151","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Secondary displacement in distal forearm fractures in children: adequate positioning of the wrist in the cast is more important than cast index"],"prefix":"10.1097","volume":"32","author":[{"given":"Rok","family":"Kralj","sequence":"first","affiliation":[{"name":"Pediatric Surgery Department, Children\u2019s Hospital Zagreb, Zagreb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domagoj","family":"Pe\u0161orda","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Children\u2019s Hospital Zagreb, Zagreb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorotea","family":"Kereti\u0107","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, General Hospital Vara\u017edin, Vara\u017edin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Ivelj","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Children\u2019s Hospital Zagreb, Zagreb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Bum\u010di","sequence":"additional","affiliation":[{"name":"Medical School of the \u2018Josip Juraj Strossmayer\u2019 University Osijek, Osijek"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor","family":"Bum\u010di","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Children\u2019s Hospital Zagreb, Zagreb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stjepan","family":"Vi\u0161nji\u0107","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Children\u2019s Hospital Zagreb, Zagreb"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rado","family":"\u017dic","sequence":"additional","affiliation":[{"name":"Department for Plastic, Reconstructive and Aesthetic Surgery, Clinical Hospital Dubrava, Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2022,4,11]]},"reference":[{"key":"R1-20250526","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ocl.2014.11.003","article-title":"Distal radius-ulna fractures in children.","volume":"46","author":"Pannu","year":"2015","journal-title":"Orthop Clin North Am"},{"key":"R4-20250526","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/01241398-199403000-00015","article-title":"Short arm plaster cast for distal pediatric forearm fractures.","volume":"14","author":"Chess","year":"1994","journal-title":"J Pediatr Orthop"},{"key":"R6-20250526","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1302\/0301-620X.84B3.0840413","article-title":"Management of completely displaced metaphyseal fractures of the distal radius in children: a prospective, randomised controlled trial.","volume":"84-B","author":"McLauchlan","year":"2002","journal-title":"J Bone Joint Surg Br"},{"key":"R7-20250526","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00590-014-1553-6","article-title":"The outcomes of displaced paediatric distal radius fractures treated with percutaneous Kirschner wire fixation: a review of 248 cases.","volume":"25","author":"Ramoutar","year":"2015","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"R8-20250526","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/01.bpo.0000158780.52849.39","article-title":"Cast immobilisation versus percutaneous pin fixation of displaced radial fractures in children: a prospective, randomised study.","volume":"25","author":"Miller","year":"2005","journal-title":"J Paediatr Orthop"},{"key":"R9-20250526","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1007\/s00068-018-1011-y","article-title":"Displaced distal radius fractures in children, cast alone vs additional K-wire fixation: a meta-analysis.","volume":"45","author":"Sengab","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"R10-20250526","first-page":"681","article-title":"Displaced distal end radius fractures in children treated with Kirschner wires - a systematic review.","volume":"82","author":"Khandekar","year":"2016","journal-title":"Acta Orthop Belg"},{"key":"R11-20250526","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.injury.2012.11.001","article-title":"Re-displacement of stable distal both-bone forearm fractures in children: a randomised controlled multicentre trial.","volume":"44","author":"Colaris","year":"2013","journal-title":"Injury"},{"key":"R12-20250526","first-page":"CD012470","article-title":"Interventions for treating wrist fractures in children.","volume":"12","author":"Handoll","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"R13-20250526","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s00068-014-0483-7","article-title":"Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children?","volume":"41","author":"Wendling-Keim","year":"2015","journal-title":"Eur J Trauma Emerg Surg"},{"key":"R14-20250526","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s00402-014-2091-8","article-title":"Think twice before re-manipulating distal metaphyseal forearm fractures in children.","volume":"134","author":"Roth","year":"2014","journal-title":"Arch Orthop Trauma Surg"},{"key":"R15-20250526","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/BPO.0000000000000196","article-title":"Outcomes of long-arm casting versus double-sugar-tong splinting of acute pediatric distal forearm fractures.","volume":"35","author":"Levy","year":"2015","journal-title":"J Pediatr Orthop"},{"key":"R16-20250526","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1302\/0301-620X.87B6.15648","article-title":"Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction.","volume":"87","author":"Zamzam","year":"2005","journal-title":"J Bone Joint Surg Br"},{"key":"R17-20250526","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/0020-1383(95)00136-0","article-title":"Forearm fractures in children: avoiding redisplacement.","volume":"26","author":"Haddad","year":"1995","journal-title":"Injury"},{"key":"R18-20250526","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/01241398-199403000-00014","article-title":"The management of isolated distal radius fractures in children.","volume":"14","author":"Gibbons","year":"1994","journal-title":"J Pediatr Orthop"}],"container-title":["Journal of Pediatric Orthopaedics B"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BPB.0000000000000976","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T22:03:14Z","timestamp":1748296994000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BPB.0000000000000976"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,11]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/bpb.0000000000000976","relation":{},"ISSN":["1060-152X"],"issn-type":[{"type":"print","value":"1060-152X"}],"subject":[],"published":{"date-parts":[[2022,4,11]]}}}