Cast Index As A Predictor of Loss of Reduction in Colles Fracture in Adults

Background: Distal radius fractures are common orthopedic injuries, particularly affecting young males and older women. In elderly patients, conservative management with closed reduction and casting is often preferred due to surgical contraindications. The cast index, a ratio of sagittal-to-coronal width at the fracture site, has been suggested as a predictor of treatment success, though its role in elderly patients remains underexplored. Aim: This study evaluates the predictive value of the cast index in determining clinical and radiographic outcomes in elderly patients with distal radius fractures managed conservatively. Methodology: A prospective observational study was conducted at K.S. Hegde Medical Academy, Mangalore, from September 2022 to April 2024. Sixty patients with dorsally displaced, metaphyseal, extra-articular distal radius fractures undergoing closed reduction were included. The cast index was assessed using X-rays on Days 1, 8, and 42. Statistical analysis was performed using SPSS 24.0, with significance set at p < 0.05. Results: Radial height increased significantly from 7.88 ± 2.75 mm (Day 1) to 8.90 ± 3.06 mm (Day 42) (p=0.001). Post-hoc analysis confirmed significant changes between Days 1 and 8 (p=0.008) and Days 1 and 42 (p=0.001). Ulnar variance also showed a significant increase from Day 8 to Day 42 (p=0.001). Volar tilt exhibited a minor but significant increase (p=0.031). Conclusion: These findings emphasize the importance of radiographic monitoring in elderly distal radius fractures. Age and sex influence fracture displacement, with older patients at higher risk. Further research is needed to refine predictive models for optimizing conservative treatment.