Abstract
Background: Distal metaphyseal forearm fracture is one of the common injuries in children. Closed reduction and above elbow cast is the standard method of treatment but reported to be associated with redisplacement rate of 7-25%. Closed reduction and fixation with percutaneous Kirschner wire is an alternative treatment option to prevent redisplacement. Methods: Thirty five children (group I) of age between 6 to 13 yrs with displaced ( more than 50% of cortical diameter) or angulated (more than 20°) distal metaphyseal forearm fracture managed with closed reduction and above elbow cast were compared with 21 children (group II) managed with closed reduction and percutaneous crossed Kirschner fixation. Clinical outcomes and complications were compared in both groups after 12 weeks of follow up. Results: Preoperative variables in both the groups were comparable. Mean loss of elbow flexion and extension (12° vs. 4°, p =0.08), wrist dorsflexion and palmerflexion (27° vs. 14°, p=0.12) and forearm supination and pronation (27° vs. 15°, p= 0.143) were more in group I but were statistically not significant. Complications rate (28.4% vs. 19.04%, p= 0.04) was higher in group I (such as fracture redisplacement and swelling) than in group II (pin tract infection). Conclusions: Grossly displaced or angulated distal metaphyseal forearm both bone fracture in children treated with either closed reduction and above elbow cast or closed reduction with crossed Kirschner wire fixation have no statistically significant clinical outcomes in terms of loss of movement of elbow, wrist and forearm but complication rate is higher in cast group. Percutaneous Kirschner wire fixation prevents redisplacement. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8133 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 1-6
Highlights
Distal forearm bone fractures comprise 75% of all forearm fracture in children and are mostly treated with closed reduction and cast application but recently the trends are changing towards primarily closed reduction and because of extremely well remodeling capacity of fracture in children but displacement requiring remanipulation have poor results and creates significant parental distress.[10] percutaneous Kirschner wire (K wire) fixation to prevent redisplacement of the fracture in the cast.[1,2,3,4,5]
All fractures were managed with closed reduction followed by cast or percutaneous K wire fixation within 24 hours of hospital admission but injury-treatment interval varied between six hours to five days
In a randomized controlled trial, McLauchlan GJ et al found that percutaneous K wire fixation is safe and reliable way of maintaining fracture alignment for completely displace distal radius fracture in children.[9]
Summary
Distal forearm bone fractures comprise 75% of all forearm fracture in children and are mostly treated with closed reduction and cast application but recently the trends are changing towards primarily closed reduction and because of extremely well remodeling capacity of fracture in children but displacement requiring remanipulation have poor results and creates significant parental distress.[10] percutaneous Kirschner wire (K wire) fixation to prevent redisplacement of the fracture in the cast.[1,2,3,4,5] The reported incidence of displacement of metaphyseal fracture of distal radius in cast varies from 7% to 25% with various studies.[3,6] Poor casting technique, presence of associated fracture or plastic deformity of ulna, initially grossly displaced and angulated fracture of radius and increased residual angulations and displacement after reduction areMany authors recommend use of percutaneous K wires for fracture fixation in initially grossly displaced and angulated fracture with associated ulna fracture but these studies have either included all types of distal radius fracture including epiphyseal injury and isolated radius fracture or used single K wire or are retrospective studies.[2, 11, 12] considered to be the factors responsible for displacement after closed reduction and cast application.[1,7,8,9] Some degree of residual angulations and displacement are acceptedThe present prospective cohort study compares clinical outcomes in children with grossly displaced and angulated distal both bone metaphyseal fractures treated with eitherVolume 2-: Number 1, Jan-Jun, 2011Nepal Orthopaedic Association Journal (NOAJ) Volume 2, Number 1, JAN-JUN, 2011Management of Pediatric Displaced Distal Metaphyseal Forearm Fracture: Comparison between Cast Immobilization and Percutaneous Kirschner Wire Fixation.closed reduction and long arm cast or closed reduction with percutaneous crossed K wire fixation. Distal forearm bone fractures comprise 75% of all forearm fracture in children and are mostly treated with closed reduction and cast application but recently the trends are changing towards primarily closed reduction and because of extremely well remodeling capacity of fracture in children but displacement requiring remanipulation have poor results and creates significant parental distress.[10] percutaneous Kirschner wire (K wire) fixation to prevent redisplacement of the fracture in the cast.[1,2,3,4,5] The reported incidence of displacement of metaphyseal fracture of distal radius in cast varies from 7% to 25% with various studies.[3,6] Poor casting technique, presence of associated fracture or plastic deformity of ulna, initially grossly displaced and angulated fracture of radius and increased residual angulations and displacement after reduction are. Closed reduction and fixation with percutaneous Kirschner wire is an alternative treatment option to prevent redisplacement
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