Abstract
ObjectivesDistal radius fractures are common pediatric orthopedic injuries accounting for 25% of all fractures with a significant incidence in the age group 10-14 years. This study aims to evaluate the operative and non-operative methods of treating distal radius fractures in children.MethodsThis is a retrospective cohort study conducted on 176 children with distal radius fracture. We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022. The inclusion criteria were as follows: age of 17 years or younger, distal radius fracture with or without complete displacement and skeletal immaturity managed as of non-operative or operative groups. Patients who did not have follow-up data after the date of surgery were excluded. The statistical analysis was performed using the software SPSS version 23.0 (IBM Corp., Armonk, NY). Continuous data expressed as mean, standard deviation and discrete variables were expressed as frequency and percentages. One-way Analysis of Variance (ANOVA) was used to compare the continuous variables between groups. The Student’s t-test was used for the two-group comparison. For the comparison of discrete variables, a Chi-Square test or Fisher’s exact test was used.ResultsSeventy-seven patients were conservatively managed with cast immobilization (“non-operative” group) in comparison to 99 patients who were surgically managed (“operative” group) with either percutaneous pinning (n=56) or flexinail (n=43). Fewer patients underwent physiotherapy in the operative group with 14 (25.0%) patients for percutaneous pinning and seven (16.3%) patients for flexinail versus 31 (40.3%) patients in the non-operative group (p<0.015). There were statistically significant differences in radial inclination (p<0.001) between conservative and percutaneous pinning (22.22±2.86 vs 18.76±3.33 degrees) and percutaneous pinning and flexinail (18.76±3.33 vs 22.37±3.44 degrees). Likewise, there was a significant difference found in ulnar variance between conservative and percutaneous pinning (-0.45±2.14 mm vs -1.47±1.93 mm, p=0.012) and conservative and flexinail (-0.45±2.14 mm vs -1.59±1.90 mm, p=0.009). There were a total of 25 documented complications. Nineteen (19.8%) complications occurred in the non-operative group versus five (7.2%) and one (2.3%) complications in percutaneous pinning and flexinail groups, respectively (p=0.003). The most common complication in the non-operative group was loss of reduction while in cast and subsequent need for surgical intervention. Ten of these patients underwent percutaneous pinning whereas nine were fixed by flexinail.ConclusionThis study illustrated an overall similar success between the surgical and the conservative treatments of distal radius fractures in children. Due to the higher complication rate reported in the conservative group, the conservative treatment cannot be considered safer than the surgical treatment.
Highlights
Distal radius fractures (DRFs) are common orthopedic injuries accompanied by suffering and substantial health care costs [1,2]
We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022
Seventy-seven patients were conservatively managed with cast immobilization (“non-operative” group) in comparison to 99 patients who were surgically managed (“operative” group) with either percutaneous pinning (n=56) or flexinail (n=43)
Summary
Distal radius fractures (DRFs) are common orthopedic injuries accompanied by suffering and substantial health care costs [1,2]. DRFs represent 25% of all fractures with a significant incidence. How to cite this article Aladraj T H, Keshta A S, Mukhtar I, et al (February 23, 2022) A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children. The subsequent loss of reduction occurs in 5% to 75% of pediatric forearm fractures [5]. The closed reduction of pediatric forearm fractures is implemented with a known physiological range of supination and pronation motion. Surgeries are indicated when unstable reduction or loss of reduction in cast occurs with respect to the degree of angulation and rotation of the limb [6]. Intramedullary nails are commonly considered for internal fixation of pediatric forearm fractures due to their safety, short anesthetic duration, short hospital stay, and easy removal following placement [6]. Several complications should be kept in the surgeon’s mind such as neuropathy, stiffness, tendonitis, malunion, arthrosis, carpal tunnel syndrome, compartment syndrome, and infection [8]
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