Cast Wedging: A “Forgotten” Yet Predictable Method for Correcting Fracture Deformity

3 Rady Children’s Hospital, UCSD, San Diego, CA Many cast wedging techniques have been discussed in the literature; however, to our knowledge, these techniques have not been experimentally validated. This paper illustrates a technique and measurement methodology for reproducible wedging and validates the geometric approach to predict the correct wedge size. Fracture deformities of saw bone models were created and placed in casts. These were used to represent in-vivo fractures of both distal and mid-shaft radius fractures, as well as distal and mid-shaft tibia fractures. Cast wedge correction was performed to correct the deformities. Fifteen specimens were observed with the goal to obtain a post-wedge angulation of less than 5 degrees. Of the 15 fractures casted, 66% achieved this goal. It was found that 80% of the apex posterior type displacement did not achieve satisfactory correction. Eliminating the apex posterior type fractures resulted in a 90% success rate of acceptable alignment. In the orthopaedic literature, there are various techniques for predicting the wedge size, but there are few studies which present either clinical or experimental data to support their method. This study validates the technique of geometric analysis for fracture reduction using cast wedging. The results indicate that angulation can be corrected to less than 5 degrees for fractures with isolated varus, valgus, or apex anterior deformities with 90% success. Alternative methods should be considered for apex posterior type deformities.