Abstract
Aim
Up to 34% of fractures of the distal radius in children can ‘re-displace’ early after reduction. Main risk factors are initial displacement (bayonet apposition, > 50% translation, and > 30°angulation), isolated distal radius fracture, associated ulna fracture at the same level, inadequate initial closed reduction and poor casting technique. This study was to identify the rate of ‘re-displacement’ following first successful reduction in distal radius fractures. We also assessed the risk factors associated with initial injury and compared the efficacy of the available indices to assess the quality of casting.
Materials & Methods
We performed a case note based radiographic analysis of 90 distal radius fractures treated at our centre from 2005 to 2008. A cohort of 18 patients with re-displacement was compared with 72 patients with maintenance of reduction. Radiological indices were calculated to assess the quality of casting technique. The patient and fracture demographics were compared between the two groups. Statistical analysis was carried out using ANOVA, Fisher's Exact Test and multiple logistic regression analysis.
Results
The rate of ‘re-displacement’ in our study was 20 %. A desirable cast index of < 0.7 was achieved in 4 out of 55 cases treated with cast alone. A significant difference (p< 0.008) was observed in the Three Point Index, the degree of comminution (< 0.01) and the quality of the initial reduction (< 0.003).
Conclusion
We recommend careful identification of high risk factors and appropriate stabilisation for potentially unstable fractures at first treatment. The magnitude of initial deformity, the comminution, and the amount of remaining skeletal growth must all be considered in the decision making process. Further training to improve the quality of casting technique cannot be over-emphasised. Trainees should be trained to calculate the Three Point Index before accepting the reduction after casting to prevent late displacement and second anaesthesia.
