Distal radial fractures are common in children. Recent outcome studies have cast doubt on the success of treatment by closed reduction and application of plaster. The most important risk factor for poor outcome is translation of the fracture. If a distal radial fracture is displaced by more than half the diameter of the bone at the fracture site it should be classified as high risk. We performed percutaneous Kirschner-wire pinning on 157 such high-risk distal radial fractures in children under 16 years of age. The predicted early and late failure rate was reduced from 60% to 14% and only 1.5% of patients had significant limitation of forearm movement of more than 15 degrees in the final assessment at a mean of 31 months after operation. There were no cases of early physeal closure or deep infection.

We measured the adenosine triphosphate (ATP) content of callus at various intervals during healing in 78 fractured tibiae in 10- to 12-week-old rabbits. The results, compared with the level in normal tissues, showed a high rate of energy metabolism in the early phase of fracture healing, which persisted until the callus was corticalised and remodelling had started. The ATP content could provide a more sensitive index to monitor fracture healing in animal studies. Our findings lend support to the need for nutritional supplements for patients with multiple fractures.