Reliability of Casting Indices Among Members of an Orthopaedic Surgery Residency

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Background:Multiple casting indices have been described to evaluate the adequacy of cast placement in pediatric distal forearm fractures. The aim of this study was to determine the intrarater and interrater reliability of the measurements of 5 common casting indices among members of an orthopaedic surgery residency program. The cast index, 3-point index, gap index, padding index, and Canterbury index were evaluated.Methods:This was a single-center prospective cohort reliability study that included 12 members of an orthopaedic surgery residency. Participants were placed into 1 of 4 groups by level of training: physician assistants, junior residents, senior residents, and attending orthopaedic surgeons. Twelve radiographs of casted pediatric distal forearm fractures were measured by each participant on 2 separate occasions. Statistical analysis using the intraclass correlation coefficient was used to determine the intrarater and interrater reliability.Results:The cast index was the only casting index to meet our criteria for good intrarater and interrater reliability.Conclusion:Continued use of the cast index as a tool to assess pediatric distal forearm cast application is supported by this study.Level of Evidence:Level 2.

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