Distal radial fractures in children: risk factors for redisplacement following closed reduction.

Abstract

Distal radial fractures represent one of the most common fractures in children with the majority treated by closed reduction and cast application. Redisplacement after manipulation can occur resulting in potential poor outcome. We performed a prospective study of children undergoing closed reduction of distal radial fracture and evaluated a range of possible risk factors contributing to loss of reduction. The prospective study included 135 displaced distal radial fractures. There were 48 girls (36%) and 87 boys (64%), with a mean age of 9.9 years (range, 3 to 17 y). The risk factors for redisplacement, which were evaluated, were age, sex, location of the fracture, preoperative fracture displacement, presence of ulna fracture, grade of surgeon, quality of reduction, quality of plaster, and residual postreduction displacement. Redisplacement occurred in 39 of 135 cases (28.8%). Initial complete displacement was the most important risk factor for loss of reduction (odds ratio, 6.94; P=0.001). Completely displaced fractures were 7 times more likely to redisplace than fractures with some bony contact or no translation. Achievement of anatomic reduction decreases the risk of redisplacement (odds ratio, 0.29; P=0.046). Ten of the 39 fractures that lost position needed a second procedure (7.4%). Completely displaced distal radial fractures that cannot be anatomically reduced have a high risk of redisplacement after closed reduction. Only a small number of fractures that lose reduction will require a second intervention. Level II.