Shahzad Anver Qureshi, Mumtaz Hussain, Ayesha Saeed, Abdul Latif Sami.
Diagnostic Accuracy of Three Point Index for Prediction of Displacement of Fractured Bone.
Pak J Med Health Sci Jan ;13(2):461-4.

Background: Diaphyseal forearm fractures accounts for 13-40% of all pediatric fractures often occurring between the ages of 5 to 14 years. Close reduction and long arm cast immobilization is the treatment of choice in majority of cases. Re-displacement is the most commonly reported complication that may requite re-manipulation. Cast indices have been described to access cast application quality. Aim: To apply three point index (TPI) to predict displacement after cast manipulation in diaphyseal forearm fractures in children. Method: 175 children with diaphyseal forearm fractures of either side were selected in the study from Oct 2015- March 2016 in the accident and emergency department of Children’s Hospital and Institute of Child Health, Lahore. Clinical assessments were done and under sedation closed reduction with an above elbow plaster of Paris casts were applied. Post manipulation radiographs of the forearm were taken and three point index (TPI) was calculated. Patients were labeled as positive or negative for displacement on the basis of TPI value. These patients were then followed at 2nd week in the OPD where X-rays were done for the assessment of displacement . Results: The mean age of 175 children presented with diaphyseal forearm fracture was 9.49 +2.95 (mean +/- SD ) years with range from 4 – 12 years. Male to Female ratio was 1.43:1. Displacement of fractured bone after cast manipulation in Diaphyseal forearm fractures on X rays was recorded as 21.14 % (n=37). Diagnostic accuracy of three point index for prediction of displacement after cast manipulation in diaphyseal forearm fractures in children , where sensitivity, specificity, Positive predictive value and negative predictive value was calculated as 78.38%, 92.02%, 72.5% and 94.07% respectively. Conclusion: The diagnostic accuracy of three point index for prediction of displacement after cast manipulation in diaphyseal forearm fractures in children taking x-ray findings as gold standard is higher but being primary data it needs some other trials for validation.

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