Abstract
There is limited evidence to support decision-making in adolescents with metaphyseal distal radius fractures. This study aims to review injury patterns, treatments, and clinical outcomes in this age group. Patients aged 11-16years presenting with metaphyseal distal radius fractures were obtained from our institutional trauma database. Radiographs and records were reviewed to obtain injury details, management, complications, and long-term sequelae. One hundred and five fractures were included. Mean age was 12.6years and 79% occurred in males. 75.2% were angulated and 24.8% off-ended. The median initial angulation was 22.1° (2.3-46.7), and the majority were dorsally displaced (74.3%). Emergent management for 91 (86.7%) patients was surgical with either manipulation under anaesthesia (MUA) and cast in theatre (59.3%), Kirschner wire (K-wire) fixation (35.8%), or open reduction internal fixation (ORIF) (3.3%). Fourteen patients were initially managed non-operatively, and 71.4% of these re-displaced requiring surgery. There was no statistical difference in final angulation of fractures managed with MUA and cast or fixation (5.35 vs. 5.5°, respectively). Complications occurred in 14.3%, including two cases of osteomyelitis. Twenty cases had final angulation of greater than 9°, but none underwent corrective osteotomy. In adolescents, metaphyseal distal radius fractures have a higher risk of early re-displacement when not reduced in theatre; however, both casting and fixation resulted in similar final angulation. Complications were common at 14.3%, but only occurred in those that underwent fixation. Few long-term issues were observed in those treated in cast, even with up to 20° of residual angulation.
Published Version
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