INTERVENTIONS FOR TREATING WRIST FRACTURES IN CHILDREN – A COCHRANE SYSTEMATIC REVIEW

Abstract

Background: The epidemiology of fracture in children has been reported in detail by other authors. The most common mechanism in their study was a fall in or around the house onto an outstretched hand causing a fracture of the distal radius and ulna. These injuries accounted for 35.8% of all fractures in this age group and the annual incidence was estimated to be 16 per 1000 children in the UK.

The controversial issues in the management of distal radius fracture involve what constitutes a degree of fracture displacement and angulation likely to be compensated by remodelling with growth over time, indications for fracture stabilisation with wires or other invasive methods compared with plaster casting alone, details of the position of the arm during immobilisation in a cast, and whether the cast should immobilise the wrist alone or both, the wrist and the elbow. The management of buckle fractures of the distal radius is relatively uncontroversial, involving splintage for symptomatic relief from pain. Some authors have advocated removable wrist supports, with discontinuation of splintage at the parents’ discretion.

We performed a systematic review of all areas of the management of distal radius metaphyseal fractures in children. Growth plate injuries were not included for analysis.

Methods: Any randomised or quasi-randomised controlled trials which compared types of immobilisation and the use of wire fixation for distal radius fractures in children were included.

Types of outcome measures:

• Radiological deformity

• Effect of cast index

• Complications of k-wiring

• Remanipulation rates

• Compliance with splintage

• Cost of various forms of splintage

• Effect of intact ulna

• Upper limb function while immobilised

• Wrist and elbow ROM

10 studies complied with the inclusion criteria and were analysed using Review Manager software provided by the Cochrane Collaboration

Summary of Results:

Regarding displaced metaphyseal fractures:

• K wire fixation reduces redisplacement

• There is no proven increase in complications with k wires

• Intact ulna favours redisplacement

• Long casts do not reduce displacement

• Short casts allow better early function

Regarding stable compression fractures:

• Removable splints are not associated with displacement

• Patients prefer removable splints for buckle fractures

• Removable splints cause less discomfort and allow better early function