Rate Of Redisplacement Research Articles

Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy: a systematic review and meta-analysis.

Up to 90% of nonambulatory patients with cerebral palsy (CP) experience hip displacement during their lifetime. Reconstructive surgery is recommended. Redisplacement rate is an outcome parameter. In a systematic literature review (MEDLINE, Embase and CENTRAL databases) until January 2023 we searched for reports with redisplacement rates after bony hip reconstructive surgery in nonambulatory patients. Quantitative data synthesis, subgroup analysis and meta-regression with moderators were carried out. The pooled mean redisplacement rate was 16% (95% CI: 12-21%) with a prediction interval of 3-51% (Q: 149; df: 32; P < 0.001; I2: 78%; τ2: 0.67 and τ: 0.82) in 28 studies (1540 hips). Varus derotation osteotomy (VDRO) alone showed a higher redisplacement rate than VDRO + pelvic osteotomy (30% vs 12%, P < .0001). Mean age in the VDRO-alone subgroup was 7.1 years and in the combined group 9.5 years (P = .004). In meta-regression, lower redisplacement rates were observed with higher preoperative migration index (MI) (correlation coefficient: -0.0279; P = .0137), where comprehensive surgery was performed. Variance in true effects are explained by type of bone surgery (57%), preoperative MI (11%), age (5%) and MI for definition of failure (20%). No significant reduction in the redisplacement rate could be observed over the mid-years of studies (1977-2015). Our pooled data support the more extensive surgical approach in patients with high preoperative MI and emphasize the superiority of combined surgery. Studies should report a coordinated set of parameters and outcome classifications according to internationally accepted gradings to reduce redisplacement in future.

Redisplacement of reduced distal radius fractures in adults: does the type of casting play a role? The CAST study, a multicentre cluster randomized controlled trial.

It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer the redisplacement of fewer fractures and better one-year outcomes compared with plaster splinting. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure. The study included 420 patients. There was no significant difference between the rate of redisplacement of the fracture between the groups: 47% (n = 88) for those treated with a plaster splint and 49% (n = 90) for those treated with a circumferential cast (odds ratio 1.05 (95% confidence interval (CI) 0.65 to 1.70); p = 0.854). Patients treated in a plaster splint reported significantly more pain than those treated with a circumferential cast, during the first week of treatment (estimated mean NRS 4.7 (95% CI 4.3 to 5.1) vs 4.1 (95% CI 3.7 to 4.4); p = 0.014). The rate of complaints relating to the cast, clinical outcomes and PROMs did not differ significantly between the groups (p > 0.05). Compartment syndrome did not occur. Circumferential casting did not result in a significantly different rate of redisplacement of the fracture compared with the use of a plaster splint. There were comparable outcomes in both groups.

Factors Associated with Re-Displacement after Nonsurgical Treatment of Distal Radius Fractures in Adults: A Retrospective Study.

Closed reduction combined with external fixation is a frequently utilized approach for treating distal radial fractures in adults. Nonetheless, the potential for re-displacement following external fixation remains. Analyzing the factors influencing re-displacement after nonsurgical treatment of distal radial fractures in adults is vital for preventing re-displacement and making prognostic assessments. A retrospective analysis was performed on 884 patients who underwent nonsurgical treatment for distal radius fractures in the reduction room of the Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine at Tianjin Hospital, Tianjin, China, between July 2019 and December 2022. Patients were categorized into two groups, namely displaced and nondisplaced, based on radiographic outcomes. Factors affecting fracture re-displacement were examined, including sex, age, side, AO/OTA type, external fixation, and radiographic outcomes at pre-reduction and immediate reduction. Logistic regression analysis was employed to identify the risk factors for fracture re-displacement, and ROC curves were constructed. Among the 884 patients, 563 (63.69%) experienced re-displacement after fracture reduction. There were no statistically significant differences (p > 0.05) between the two groups in terms of gender, external fixation method, and palmar tilt angle at pre-reduction and immediate reduction, while significant differences (p < 0.05) were observed in age, side, AO/OTA type, and radial inclination, radial length, and radiographic outcomes of ulnar variance at pre-reduction and immediate reduction. Multifactorial logistic regression analysis revealed that age (odds ratio [OR] = 1.027, p < 0.001), AO/OTA type (OR = 2.327, p = 0.005), ulnar variance at pre-reduction (OR = 1.142, p = 0.048), and ulnar variance at immediate reduction (OR = 1.685, p < 0.001) were significant factors (p < 0.05) associated with re-displacement following nonoperative treatment of adult distal radius fractures. For patients aged ≥60 years, the amount of missing radiographic outcomes was positively correlated with age. The receiver operating characteristic curve demonstrated that age ≥65.5 years, ulnar variance >3.26 mm at pre-reduction, and ulnar variance >2.055 mm at immediate reduction were high-risk factors for fracture re-displacement. Nonsurgical treatment of distal radius fractures exhibits a higher rate of re-displacement. Age, AO/OTA type, pre-reduction, and immediate reduction ulnar variance are key factors predicting fracture re-displacement.

Complication rates, fluoroscopy exposure time, and functional outcomes of the two K-wire fixation methods for distal radius fractures in pediatric patients; mini-incision as a feasible surgical option

Objectives. In this study, we aimed to compare complication rates and fluoroscopy exposure time, as well as to analyze the functional results of percutaneous K-wire fixation and K-wire fixation with mini-open techniques in pediatric distal radius fractures. Materials and Methods. In this retrospective design study, one-hundred patients with completely displaced fracture of the distal radius were evaluated in terms of demographic data, radiological and functional evaluations, fluoroscopy exposure time, and complications. In Group 1, 50 patients were treated by closed reduction and percutaneous K wire application. In Group 2, 50 patients were treated with close reduction and K-wire fixation using a mini-incision. Results. There were no statistically significant differences between the two groups in terms of age, fracture degree, reduction degree, and follow-up duration. We found the fluoroscopy time and redisplacement rate were significantly lower in group 2. We did not notice tendon irritation and neuropraxia complications in any of the patients in group 2. We observed good functional results and no malalignment in both groups. Conclusions. The mini-open incision technique had lower complication rates and fluoroscopy durations. Based on the results of this study, K-wire fixation with the mini-open technique may be recommended as an alternative method for pediatric distal radius fractures.

Outcomes of Paediatric Distal Radius Metaphyseal Fractures

Background: Manipulation and cast immobilisation is the accepted gold standard for management of distal radius metaphyseal fractures in children, with the use of Kirschner wires (K-wires) in cases with potential instability. The primary aim of this study was to determine the outcome of these fractures treated with our current management protocol. We also sought to identify possible risk factors for redisplacement. Methods: A retrospective study was conducted on 61 children with displaced distal radius metaphyseal fractures under the age of 16 years. Fifty-three patients were treated with manipulation and casting only, while eight patients had K-wire fixation. The primary outcome measured was redisplacement during follow-up. Initial complete displacement, an associated ulna fracture, the quality of reduction, cast and padding indices were assessed as possible risk factors for redisplacement. Results: A redisplacement rate of 18.8% was reported. We found a statistically significant association between redisplacement and non-anatomical reduction (P = 0.001), cast index (P = 0.030) and padding index (P = 0.031). Non-anatomical reduction resulted in 23.6 times more likelihood of redisplacement (P = 0.008) compared to anatomical reduction. Complete displacement and the presence of an ulna fracture had no effect on redisplacement. Conclusions: Our current treatment protocol is safe and effective based on the redisplacement rate of 18.8% which is marginally lower than current standards reported in the literature. Poor casting technique and non-anatomical reduction were found to be significant predictors of redisplacement. We suggest that K-wires be used if anatomical reduction is not achieved in older children with limited remodelling capacity.

Comparison of Clamp Reduction and Manual Reduction of Syndesmosis in Rotational Ankle Fractures: A Prospective Randomized Trial

An optimal outcome of surgical treatment for a syndesmotic injury depends on accurate reduction and adequate fixation. It has been suggested that the use of a reduction clamp for reduction of the syndesmosis results in better reduction and a lower rate of redisplacement than manual reduction. However, these concepts have never been scientifically evaluated. We compared these 2 methods in a prospective randomized trial. A total of 85 acute ankle rotational fractures combined with syndesmotic injury were randomized to syndesmosis reduction with either a reduction clamp or manual manipulation. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space immediately postoperatively and at the final follow-up examination. Ankle joint range of motion, visual analog scale score, Olerud–Molander ankle scoring system, and complications were obtained at the last follow-up visit to assess the clinical outcomes. Of the 3 radiographic measurements, the tibiofibular clear space and tibiofibular overlap differed significantly between the 2 groups (p < .05). The clinical outcomes did not differ significantly between the 2 groups (p > .05). Although differences were found in the radiographic measurements, most syndesmoses in both groups were within the normal range at the final follow-up visit, and the 2 methods of syndesmosis reduction provided similar clinical outcomes. Accordingly, the results of the present study suggest that both of these methods are effective and reliable for reduction of the syndesmosis in rotational ankle fractures.

Predictive factors for re-displacement in diaphyseal forearm fractures in children—role of radiographic indices

Background and purpose — Manipulation and cast immobilization is the primary management for diaphyseal forearm fractures in children, and re-displacement is the most common complication. We wanted (1) to analyze the incidence of re-displacement in a group of children treated with close reduction and casting; (2) to determine predictive factors such as demographics, mechanism of injury, affected bone, fracture pattern, degree of initial displacement and angulation, and reduction accuracy; and (3) to determine the prognostic effect of previously defined radiographic indices.Patients and methods — We prospectively studied 269 consecutive children with closed and complete middle-third diaphyseal fractures treated with close reduction and casting from October 2014 to April 2015. Factors analyzed included demographics, initial fracture features, having a non-anatomical reduction, and the radiographic indices of cast quality.Results — There were 189 fractures of both bones (70%) and 80 solitary fractures (30%). The overall re-displacement rate was 11%. According to multivariable analysis, independent predictors of re-displacement were initial angulation >10° (RR =5) and failure to achieve an anatomical reduction (RR =2). Statistically significant radiographic indices regarding increased rate of re-displacement included cast index ≥0.7 (RR =5), Canterbury index ≥1.1 (RR =3), and 3-point index ≥0.8 (RR =6).Interpretation — Our results suggested that fractures with a higher degree of initial angulation and non-anatomical reduction more often result in re-displacement. Moreover, the casting quality examined with the radiographic indices played an important role in the success of a non-operative management.

Rereduction for Redisplacement of Both-Bone Forearm Shaft Fractures in Children.

There is a high rate of redisplacement after closed reduction and cast treatment of displaced both-bone forearm shaft fractures in children. Little evidence is available on the efficacy of rereduction of these redisplaced fractures. This study evaluates the impact of rereduction on radiographic outcomes and compares the cost to surgical stabilization. This retrospective study included 31 children (mean age, 6.3 y; 18 boys) treated with rereduction for redisplacement of a displaced both-bone forearm shaft fracture between 2008 and 2013. Angulation was measured on anteroposterior and lateral radiographs of the radius and ulna at injury, after reduction, at redisplacement, after rereduction, and at fracture union. Average procedure costs for rereduction and surgical stabilization were calculated. Initial reduction decreased apex volar angulation (initially >20 degrees) of both bones to a median of ≤2 degrees. After an average of 15 days (range, 4 to 35 d), apex volar angulation of the radius worsened to 9 degrees, and apex ulnar angulation worsened to >10 degrees for both bones. For every 5 days after initial reduction, apex ulnar angulation of the radius worsened by 4 degrees. Rereduction reduced apex ulnar and volar angulation of both bones to <5 degrees, which was maintained after cast removal. There were no complications. The average procedure cost for rereduction was $2056 compared with $4589 for surgical stabilization with or without implant removal. Rereduction of both-bone forearm shaft fractures after redisplacement following initial closed reduction had satisfactory radiographic outcomes and is a safe, effective, and less expensive option than surgical stabilization. Level IV-therapeutic.

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

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.

Predicting redisplacement after manipulation of paediatric distal radius fractures: the importance of cast moulding.

The majority of displaced distal radius fractures are managed by closed reduction and cast immobilisation. Redisplacement is associated with initial displacement, imperfect reduction and quality of cast. The aim of this study was to establish which factors predict the risk of redisplacement. A retrospective analysis between September 2010 and April 2013 of children who underwent closed manipulation and cast immobilisation for a distal third radius fracture was performed. Open fractures, those treated with fixation, and cases with associated dislocations or physeal injuries were excluded. Initial fracture translation and angulation, the distance from the physis and the presence of an ulna fracture were recorded. Intra-operative radiographs were analysed to assess reduction, the cast index and gap index. Clinic records and post-operative radiographs were reviewed to identify redisplacement or further surgical intervention. During the study period, 107 children underwent closed reduction and casting: 82 boys (76.6 %) and 25 girls (23.4 %), and the mean age of the group was 10 years. Twenty-nine children (27 %) suffered a radiographic redisplacement although only five children underwent a second surgical intervention. Statistically significant risk factors for redisplacement were initial fracture translation (p < 0.001), success of reduction (p < 0.001) and associated ulna fracture (p = 0.021). Both the mean cast index (0.81 vs. 0.78) and mean gap index (0.16 vs. 0.14) were higher in the redisplaced group, but this did not reach statistical significance. Closed reduction and immobilisation of paediatric distal radius fractures is associated with a high redisplacement rate. Initial fracture type and success of reduction are key risk factors.

Quality of Plaster Molding for Distal Radius Fractures Is Improved Through Focused Tuition of Junior Surgeons

Successful nonoperative management of distal radius fractures requires an adequately reduced fracture held in a well-molded cast. The purpose of this study was to determine whether a targeted teaching session to the same group of junior doctors led to objective improvement in fracture reduction and plaster molding and hence a decrease in the redisplacement of these fractures. Retrospective review. Level I academic trauma center. A retrospective review of all dorsally angulated distal radius fractures treated in plaster that presented to our plaster room over a 4-week period (group 1, n = 52). This was followed by the intervention and a subsequent 4-week prospective review (group 2, n = 36). Radiographs were reviewed before manipulation, after manipulation, and at follow-up by a single senior orthopaedic trainee using predetermined criteria. A targeted teaching session on fracture reduction and cast molding to the same group of junior doctors involved in managing all these cases. Adequate fracture reduction, plaster molding, redisplacement, and further intervention before and after the targeted intervention. In group 1, 85% had adequate fracture reduction but only 36% showed adequate molding. This was improved in group 2%-94% adequate reduction and 65% adequate molding (P = 0.022). The rate of redisplacement was improved from 65% to 44% in group 2. In both groups, the rate of redisplacement was around 20% for adequately reduced and molded fractures, compared with around 90% for adequately reduced but inadequately molded cases (P < 0.001). The rate of further intervention improved from 27% to 8% (P = 0.052). We recommend that specific teaching focusing on fracture reduction and molding techniques is included in orthopaedic juniors' induction teaching or as a separate session. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Closed reduction with pinning of metaphyseal fractures of the distal radius in children

Background Recent studies have shown favorable outcome with closed reduction and pinning for displaced complete fractures of the distal radius in children compared with closed reduction and casting alone, which showed a high rate of redisplacement in addition to complications that develop from extreme positions for maintaining reduction and anxiety developed from remanipulation of fractures. Methods During the period between July 2008 and July 2010, 30 cases of metaphyseal fractures of the distal radius were managed by closed reduction and primary pinning with the application of a forearm cast. Results No case of redisplacement was reported until complete healing, and no major complications were observed. Conclusion It appears that primary pinning for distal radius fractures is a simple and safe method that can be used as an alternative to closed reduction and casting alone in the treatment of displaced metaphyseal fractures of the distal radius in children (from 5 to 12 years), and this study supports previous studies on this method of treatment.

Management of Pediatric Displaced Distal Metaphyseal Forearm Fracture: Comparison between Cast Immobilization and Percutaneous Kirschner Wire Fixation

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

Redisplacement of Diaphyseal Fractures of the Forearm After Closed Reduction in Children: A Retrospective Analysis of Risk Factors

Manipulation and plaster fixation is the primary management for diaphyseal fractures of the radius and/or ulna in children. This study was designed to evaluate risk factors of fracture redisplacement after closed reduction and cast immobilization. Retrospective study. Tertiary hospital. Fifty-seven children with fractures of the radius were included. The medical records of patients with/without ulna treated with closed reduction and casting were reviewed. Data analyzed were age, sex, dominant hand, fracture pattern, reduction quality, experience of the surgeon, and type of anesthesia. Logistic regression was used for multivariate analysis. There were 41 (71.9%) males and 16 (28.1%) females with a mean age of 9.74 ± 3.07 years. There were 53 radius fractures and 54 ulna fractures, and 22 subjects experienced redisplacement. The redisplacement rate of radius fractures was 34% and of ulnar fractures was 27.8%. Multivariate analysis showed that the factors associated with redisplacement of radius fractures were fair reduction quality [odds ratio (OR), 8.45] and complete fracture (OR 9.62) and those for redisplacement of ulna fractures were fair reduction quality (OR 8.10) and complete fracture (OR 8.43). Poorer reduction and complete fracture are more likely to result in redisplacement, and surgical management may be considered in these cases.

The increasing incidence of paediatric diaphyseal both-bone forearm fractures and their internal fixation during the last decade

BackgroundThe incidence of children's forearm fractures is increasing worldwide. This is different from the declining trend observed in the overall injury rate, and the reason for the increase is not known. Diaphyseal forearm fractures comprise 3–6% of all paediatric fractures, and they offer a challenge to their treatment. The purpose of this study was to evaluate the incidence of diaphyseal both-bone forearm fractures in children during the last decade in Northern Finland. Another objective was to study the background factors, treatment, and re-displacement of these fractures. Materials and methodsAll 168 children (<16 years) admitted to our paediatric trauma centre due to diaphyseal both-bone forearm fractures during 2000–2009 were included. The type of injury, background factors, radiographics, treatments and re-dislocations were reviewed. The age-related incidence rates were evaluated. ResultsThe incidence of diaphyseal both-bone forearm fractures increased 4.4-fold (95% CI 2.0–10.8; P<0.001) between 2000 (8.2/100000) and 2009 (35.9/100000). The increase in the incidence was accelerating (P<0.001) and the overall increase was 338%. The incidence of surgical treatment for diaphyseal fractures increased 4.2-fold (95% CI 1.9–10.4, P=0.001), which is in relation to increasing number of fractures. However, internal fixation increased from 13.3% in 2000–2001 to 52.7% in 2008–2009 (P=0.015), as an alternative to conservative treatment. The re-displacement rate was high (29.9%) amongst the patients with conservative treatment compared to those who were invasively operated (1.4%) (P<0.001). The mean age of the patients increased by 2.4 years in the study period (P=0.019). Trampoline was the most important and still increasing reason for the fractures. At the beginning of the study, there were no trampoline-related fracture, but towards the end of the study 30–41% of the fractures were caused by a trampoline injury (P=0.004). ConclusionsThere was an accelerating increase in the incidence of paediatric diaphyseal both-bone forearm fractures during the last decade. Trampoline was the most important and still increasing reason for these fractures. The mean age of the patients was increasing. Increasing proportion of diaphyseal both-bone forearm fractures was treated operatively. Re-displacement was unusual amongst operated cases.

Treatment of the displaced femoral neck fractures: indications and limits of osteosynthesis.

Opinions about the optimal treatment of displaced femoral neck fractures in the elderly are still divided. The two main options are internal fixation and arthroplasty. The aim of our study was to determine the most adequate surgical procedure for displaced, Garden type III-IV femoral neck fractures: which patients should undergo an osteosynthesis or primary arthroplasty, with the least prospect of complications? We analyzed 489 femoral neck fractures treated by percutaneous osteosynthesis. We also compared the results of displaced fractures treated with primary arthroplasty versus secondary arthroplasty performed due to the failure of primary osteosynthesis. The rate of redisplacement in the Garden type III group was 7.6%, and in the Garden type IV group, it was 25.5%, mainly in the case of subcapital fractures. Also, walking ability was examined 4months after injury. In the ASA score II-III group, most of the patients were able to walk with or without walking aids, but in the case of ASA score IV, most of them were immobile or died during the hospital or posthospital phase. Our research also proved that, in cases of femoral neck fractures treated with primary arthroplasty, the complication rate is lower than after secondary arthroplasty due to failure of the primary osteosynthesis. Based on our results, we recommend osteosynthesis in the case of Garden type III femoral neck fractures and, in turn, arthroplasty with respect to the high rate of early redisplacement in the case of Garden type IV fractures, especially in the case of subcapital fractures. For patients confined to a bed and in poor general condition (ASA score IV), the first choice treatment option is the minimally invasive percutaneous osteosynthesis.

Redisplacement Rates after Reduction and Cast Immobilization of Isolated Distal Radial Fractures

Background The maintenance of satisfactory alignment in distal radial fractures following closed reduction and casting of the forearm is challenging. Redisplacement rates of between 2 and 91% have been described, mostly for Western populations and for fractures involving both the forearm bones. The local scenario is unexplored. Objective This study sought to determine the rate of redisplacement in isolated closed distal radial fractures in children aged 6-15 years and the factors contributing to the redisplacement. Setting The Kenyatta National Hospital, a teaching and referral hospital in Kenya. Patients and Methods This was a prospective study carried out between June 2005 and February2006. Patients were recruited from casualty, where the fracture was reduced and casted. Immediate check x-rays were taken to ascertain satisfactory alignment. At follow up the fractures were evaluated for redisplacement in the fracture clinic in the second and fourth weeks with further check x-rays. Redisplacement was regarded as the presence of dorsal or volar- angulation of greater than 200. The data was collected and entered into statistical package for social sciences (SPSS) 12.0 version. Comparison of the binomial outcomes of the factors determining the redisplacement of the distal radial fractures was carried out using Fischer’s exact test. P value

Redisplacement of paediatric forearm fractures: Role of plaster moulding and padding

Re-displacement of paediatric forearm and wrist fractures following manipulation and cast application is a common complication. Poor plaster application technique is an important risk factor for re-displacement. However, there are no reliable and validated objective radiological measurements to differentiate a well-applied plaster cast from a poorly padded and moulded cast. This study was conducted in the background of this fact. We have attempted to define simple, reliable and objective radiological measurements to determine the quality of moulding and padding of the plaster thereby predicting re-displacement of fractures in this group. The two radiographic measurements used in this study are Cast index and Padding index, which are a guide to plaster moulding and padding, respectively. Case records and radiographs of 142 children who underwent a manipulation for a displaced fracture of forearm or wrist were studied. Angulation, translation displacement, Cast index and Padding index were measured on radiographs. The sum of the Cast index and Padding index was termed as the Canterbury index. Re-displacement was seen in 44 cases (32.3%). Cast index, Padding index and Canterbury index were significantly greater in the re-displacement group as compared to the cases where no re-displacement was seen (p<0.005). Improvement in the plaster application skills as monitored by these indices reduced the re-displacement rate by 50%. We suggest that a high Cast index of more than 0.8, Padding index of more than 0.3 and the combined Canterbury index of 1.1 are important risk factors for re-displacement of these fractures.

Treatment of femoral neck fractures in Hungary with the Manninger screw

In Hungary fresh intracapsular femoral neck fractures are traditionally treated by osteosynthesis, 60% of them (3,500 cases annually) with the Manninger screw. The authors based the development of the cannulated screw fixation technique on results from research done in Sweden and on the internationally acknowledged results of their own expert group. This group has worked on the treatment of femoral neck fractures for 48 years. From 1. Nov. 1990 to 31. Dec. 2001 the authors performed 2,871 procedures using percutaneous double cannulated screw fixation combined with a special tension band plate. Follow-up assessment after 3-4 years was possible for two groups of 489 and 240 patients respectively. Results / Conclusions: It is important that the fractures are exactly reduced as soon as possible after the accident. A stable fixation configuration with one or two fixed-angle plates and three screws clearly lowers the rate of redisplacement in cases of unstable fracture (approx. 20-25% of all fractures). The authors were able to achieve an early complications rate of less than 6% by acquiring many years of experience and by modifying the method to suit the individual patient and fracture. The mortality rate was low, especially considering that patients in poor general condition, for whom no operation other than percutaneous screw fixation could have been considered, were also treated.

Conservative treatment of intra-articular fractures of the distal radius--factors affecting functional outcome.

One hundred and eleven intra-articular fractures of the distal radius in young adults that were conservatively treated were studied. At two years, 80% of fractures were rated as excellent or good by the modified Green and O'Brien scoring system. The rate of re-displacement within casts was 28%. Sixty five per cent of re-displaced fractures were treated with surgical fixation. Those re-displaced fractures treated with repeated manipulation had only 33% excellent or good result. Moreover, their initial alignment could not be preserved. Axial compression (>2 mm) and dorsal angulation (>15 degrees ) were directly related to worse functional outcome and diminished range of motion.