Abstract
PurposeThe therapy of distal radial fractures in children is expected to be as non-invasive as possible but also needs to deliver the definite care for gaining optimal reduction and stabilizing the fracture. Therefore, closed reduction and immobilization is competing with routine Kirschner wire fixation. The aim of our study was to investigate if closed reduction and immobilization without osteosynthesis can ensure stabilization of the fracture.MethodsWe chose a retrospective study design and analyzed 393 displaced distal radial fractures in children from 1 to 18 years with open epiphyseal plates studying medical files and X-rays. The Pearson’s χ2 test was applied. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an alpha level of P = 0.05.ResultsOf these studied fractures 263 cases were treated with closed reduction and immobilization. Only 38 of these needed secondary interventions, 28 of these underwent reduction after redisplacement and ten patients received secondary Kirschner wire fixation. The last follow-up examination after 4–6 weeks revealed that 96.4 % of fractures initially treated with closed reduction and immobilization were measured within the limits of remodeling. 104 of the studied fractures were treated with cast immobilization alone when displacement was expected to correct due to remodeling. Here 22.1 % of patients needed secondary reduction. Furthermore, primary Kirschner wire fixation was performed in only 25 children with unstable fractures and only one received further treatment. Interestingly, operative reports of primary closed reduction revealed that repeated maneuvers of reduction as well as residual displacement are risk factors for redisplacement.ConclusionFor the treatment of displaced distal radial fractures in children closed reduction and immobilization can be considered the method of choice. However, for cases with repeated reduction maneuvers or residual displacement we recommend primary Kirschner wire fixation to avoid redisplacement.Level of evidenceRetrospective comparative study, Level III
Highlights
Distal radial fractures are among the most common injuries in children [1, 2], and fractures at the metaphysis are especially prevalent [3, 4]
Of 393 fractures that we investigated, 263 cases were indicated to be reduced and immobilized because they did not apply for mere immobilization due to their displacement beyond the limits of remodeling
Since only 14.4 % of these fractures needed further treatment because of redisplacement and the outcome was good, we conclude that closed reduction and immobilization is an appropriate method to treat these fractures in children
Summary
Distal radial fractures are among the most common injuries in children [1, 2], and fractures at the metaphysis are especially prevalent [3, 4]. Closed reduction and cast immobilization play a major role in the treatment of these fractures in children [4, 5]. Various rates of unacceptable loss of reduction have been described in the literature [6,7,8,9,10,11,12] and many studies have been undertaken to identify the factors which increase the risk of redisplacement. Since the risk of redisplacement can be significantly reduced by the use of percutaneous pin fixation [8, 11] the initial use of Kirschner wires has been debated for fractures with an increased risk for loss of reduction [10, D. No agreement regarding a gold standard has been found to date
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