1. The document introduces the Hillingdon Cast Index (HCI), a quantitative method for assessing the effectiveness of cast moulding in treating Colles' fractures. 2. The study analyzed 183 Colles' fracture cases to compare HCI scores between patients who did and did not require surgery. It found HCI >0.96 indicated a 90% risk of displacement, while HCI <0.72 indicated an 84% risk of no displacement. 3. The HCI provides an objective measure of cast moulding quality, with properly moulded casts having lower scores. The study recommends training in manipulation and plaster application to reduce fracture redisplacement.

1. 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

2. Normal Anatomy RH RI VT Radial Inclination-23 ° Radial Height-12mm Palmer/Volar Tilt-11 °

3. 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

4. Closed Reduction CReduction Moulding Manipulation

5. Closed Reduction

6. Analysis Of Cast Application Closed Reduction and Manipulation Volar Tilt Radial Shortening Radial Inclination Moulding No method described “ HILLINGDON CAST INDEX”

7. 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)

8. Hillingdon Cast Index PA HCI-LAT/PA LAT U R POSTERIOR ANTERIOR LAT AP

9. Hillingdon Cast Index U R R U MOULDED PLASTER HCI – 0.74 PLASTER WITHOUT MOULDING HCI – 1.1 P A

10. 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

11. 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

12. Data Analysis Group I – Patients managed without operative intervention HCI - 0.78 (0.66 - 0.85)

13. Data Analysis Group II – Patients managed with operative intervention HCI-0.94( 0.74-0.1.3)

14. Data Analysis GROUP I GROUP II 29 18 28 28 28 29 15 18 8 36 56 22

15. 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)

16. HCI-0.76

17. HCI-0.74 PA LAT

18. HCI-1.1

19. HCI-0.94

20. 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