MANAGEMENT OF DISTAL RADIUS FRACTURES IN CHILDREN – DO WE NEED TO CHANGE OUR PRACTICE?

Abstract

Aim: To evaluate the outcome of displaced distal radius fracture in children & review our practice.

Methods: A retrospective review of case notes and radiographs of all children requiring orthopaedic intervention under general anaesthetic for displaced distal radius in our hospital over a period of 18 months (January 2005 to June 2006) was carried out. We had treated 72 fractures of the distal radius in same number of children. All but 3 cases were treated by primary closed manipulation & plaster immobilisation. Average age was 11.7 years (range 5 to 16 years).

We looked at the re-displacement rate amongst these children that required a second procedure. We also sought predictive factors for redisplacement if any.

Results: There were 22 female & 50 male patients. All the fractures were closed injuries with no distal neuro-vascular deficit. Of the 72 cases, 16 cases showed more than 50% initial displacement and 6 were completely displaced (off-ended). 9 cases had volar angulation.

Redisplacement of fracture after initial satisfactory reduction was seen in 9 cases (12.7%) & required a second procedure. The secondary procedure involved closed reduction and percutaneous K wire fixation in 4 patients and open reduction in 2 cases. 3 cases had closed remanipulation & change of plaster.

We reviewed the factors responsible for re-displacement after a closed reduction such as initial displacement, angulation, adequacy of initial reduction, associated ulna fracture, type of plaster, and initial post-operative images.

Average age has been 12.7 years. 3 out of 5 (60 %) completely displaced fractures treated by closed reduction and manipulation required a second procedure. Only 1 in 16 cases of incompletely displaced fracture required a second procedure.

Volar angulated fractures tend to redisplace after closed reduction, 3 out of 7cases (42 %) required a second procedure. Associated ulna fracture (22.7%) increased the risks of redisplacement.

5 out of 24 epiphyseal injuries redisplaced but these were either severely displacement or had volar angulation. 3 out of 4 cases (75 %)that were severely displaced had inadequate primary closed reduction & underwent a second procedure.

Conclusion: We would like to conclude that despite achieving a very good initial reduction, offended distal radius fractures & those with volar displacement have high risk of re-displacement. Inadequate primary reduction has invariably resulted in requiring a second procedure. It is advisable to treat such cases by primary open reduction and K wire fixation in order to prevent redisplacement.

In management of paediatric distal radius fractures, primary reduction with percutaneous Kirschner wire has better outcome and lower incidence of redisplacement in selected cases with features of complete displacement and volar angulation especially in the older age group (> 11 years).