Conservative Follow-up of Severely Displaced Distal Radial Metaphyseal Fractures in Children.

Abstract

IntroductionDistal radius fractures are the most frequent fractures seen in pediatric population and usually treated with closed reduction and casting. However, there is a risk of reduction loss and/or angulations in distal radial metaphyseal fractures. The purpose of this study is to evaluate the radiological and functional results of pediatric patients with distal radius metaphyseal fractures in which excessive displacement and/or angulations were accepted and to question upper acceptable limits in light of current literature.MethodsPatients between five and 15 years of age with displaced distal radius fractures who were treated conservatively with significant angulation or translation were included in this study. Patients’ demographic data were gathered from hospital’s digital database. Clinical and radiological evaluations of all patients were done prospectively based on the last outpatient clinic control. Range of motion of wrist and elbow joint was measured with a goniometry, neurovascular status was documented, muscle strength was assessed and finally existing deformity measurements were performed clinically. Radiological evaluation was performed on pre-reduction, post-reduction, cast removal, 6th and 12th months and final examination radiographs. All measured values were compared with uninjured side. Radiologically, the percentage of translation, the amount of angulations, the distance from the fracture to the epiphyseal line, and the radius lengths were measured. Radial inclination and palmar tilt angles as well as ulnar variance and residual angulation were measured in both antero-posterior (AP) and lateral forearm radiographs. The Mann–Whitney U test was used to compare the variables in SPSS version 21. p < 0.05 was considered statistically significant.ResultsTwenty-nine patients with a mean age of 8.8 ± 3.1 years were included in this study. The mean follow-up duration was 17.4 ± 6.7 months. Compared to the uninjured side, in 24 (83%) patients, there were no limitations on wrist movements except five patients in forearm pronation clinically. In patients with re-displacement, the mean displacement occurrence time was 13.3 ± 4.9 (7–21) days. The translational and/or angulations in AP and lateral radiographs fully remodeled at the end of 6th month.ConclusionThis study demonstrates that radial and dorsal angular deformities up to 39° and 22° volar angulation and complete displacement correct fully in children up to 10 years old. In children between 10 and 15 years, the dorsal angulation up to 38°, radial angulation up to 23°, and volar angulation up to 16° are acceptable for remodeling capacity of the child.