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