Risk factors for redisplacement in pediatric distal radius fractures after closed reduction and cast immobilisation

Abstract

Introducation: Pediatric distal radius fractures are one of the most common fractures that we see in our practice. The primary modality of treatment of the displaced fractures of distal radius in children is closed reduction and immobilization in cast. Loss of alignment in cast after an acceptable reduction is common. Twenty one to fifty percent rates of redisplacement in cast after acceptable initial reduction have been reported in literature. Methods: This prospective study included 58 fractures of distal radius and distal third shaft of radius in 57 children with radiologically open physis. Age, gender, initial displacement, associated fracture of the ulna, adequacy of reduction, cast index and gap index were evaluated as possible risk factors for redisplacement in cast. Results: A redisplacement rate of 34.48%was found in distal radius fractures of children after acceptable initial closed reduction and immobilization in cast. Initial complete displacement, degree of initial translation in coronal and sagittal plane, degree of initial angulation in the coronal plane, associated fracture of the ulna, non anatomical initial reduction and cast index were found to be significant risk factors for redisplacement. Age, gender, initial angulation in the sagittal plane and gap index were insignificant risk factors. Conclusion: Distal radius fractures in children have high rate of redisplacement in cast. Fractures with initial complete displacement, fractures with associated fracture of ulna and non-anatomically reduced fractures should either be treated by primary closed reduction and percutaneous pinning or must be followed very carefully in cast treatment. Cast index rather than gap index is a better predictor of loss of reduction in cast.