Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature

Hendrickx, Roel P. M.; Campo, Martin M.; Lieshout, Arno P. W. van; Struijs, Peter; Bekerom, Michel P.J. van den

doi:10.1007/s00402-011-1363-9

Cited by 19 publications

(10 citation statements)

References 17 publications

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“…In our study, all included children were managed with an above-elbow cast according to our institute's former clinical management protocol. Recent literature [38][39][40][41][42][43][44] Due to the retrospective nature of this research, recruitment rates were modest. Geographic dispersion of the study population meant that 27 out of 66 children were unable to revisit clinics.…”

Section: Limitationsmentioning

confidence: 99%

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Roth

Denk

Colaris

et al. 2014

Arch Orthop Trauma Surg

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Re-manipulation of distal forearm fractures in children <12 years did not improve outcomes, deeming re-manipulations unnecessary. Children ≥12 years in the conservative group achieved satisfactory outcomes despite re-angulations exceeding current guidelines. Based on observed remodelling, we now accept up to 30° angulation in children <9 years; 25° angulation in children aged 9-<12; 20° angulation in children ≥12 years, when re-angulation occurs. We conclude that clinicians should be more reluctant to perform re-manipulations.

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Section: Limitationsmentioning

confidence: 99%

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Roth

Denk

Colaris

et al. 2014

Arch Orthop Trauma Surg

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“…Of all redisplaced fractures, 61% (191/313) received secondary treatment. Excluded after full-text analysis (n=54) Results distal radius and cast not extracted (21) No full-text available (7) Adults (4) Language (2) No clear/similar definitions (7) No patient data (1) Insufficient data (6) Risk factor not analysed in other articles (6) Included articles for meta-analyses and review (n=12) (Figs. 5, 6).…”

Section: Outcomementioning

confidence: 99%

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Sengab

Krijnen

Schipper

2019

Eur J Trauma Emerg Surg

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Purpose Displaced distal radius fractures in children are common and often reduced if necessary and immobilized in cast. Still, fracture redisplacement frequently occurs. This can be prevented by fixation of fracture fragments with K-wires, but until now, there are no clear guidelines for treatment with primary K-wire fixation. This meta-analysis aimed to identify risk factors for redisplacement after reduction and cast immobilization of displaced distal radius fractures in children, and thereby determine which children will benefit most of primary additional K-wire fixation. Methods Eight databases were searched to identify studies and extract data on the incidence of and risk factors for redisplacement of distal radius fractures after initial reduction and cast immobilization in children. Results Twelve studies, including 1256 patients, showed that initial complete displacement (odds ratio [OR] 4.69, 95% confidence interval [CI] 2.98-7.39) and presence of a both-bone fracture (OR 1.95, 95% CI 1.34-2.85) were independent risk factors for redisplacement. Anatomical reduction reduced the redisplacement risk (OR 0.14, 95% CI 0.05-0.40). No significant influence on redisplacement risk could be established for female sex, experience level of the attending surgeon, Cast Index < 0.8, Three-Point Index < 0.8 and patient's age. Conclusions For children with a displaced distal radius fracture, the presence of a both-bone fracture, complete displacement of the distal radius and non-anatomical reduction are risk factors for redisplacement after reduction of their initially displaced distal radius fracture. Children with one or more of these risk factors probably benefit most of reduction combined with primary K-wire fixation.

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“…A review article was performed by Hendrickx et al in 2011 which concluded that belowelbow casts were as effective as above elbow casts in the treatment of distal-third radius and ulna fractures in children. 23 Advocates of the short-arm cast cite low redisplacement rates, fewer days off school and less interference with activities of daily living. [24][25][26] In a retrospective review of 155 children with distal radius fractures, McQuinn et al found that an initial displacement of more than 50% or a less than perfect reduction, predisposed to redisplacement.…”

Section: Factors Associated With Redisplacementmentioning

confidence: 99%

Treatment of distal radius metaphyseal fractures in children: a case report and literature review

Firth

Robertson

2017

SA orthop. j.

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Background: The management of displaced distal metaphyseal radius fractures in children is controversial-specifically the prevention of redisplacement. The aim of this article is to establish the indications for the use of Kirschner wires (K-wires) in the management of distal radius fractures in children by reviewing the current literature. The objectives were to establish the remodelling potential in children, factors associated with redisplacement, indications for using K-wires and potential complications of K-wires in distal radius fractures. Methods and results: A 7-year-old boy with a displaced distal radius fracture was taken to theatre for manipulation and percutaneous fixation with K-wires and subsequently developed a chronic osteomyelitis secondary to the K-wire insertion. Conclusion: Children under 10 years of age have excellent remodelling potential. The most important risk factors for redisplacement are complete initial displacement, non-anatomic reduction and poor plaster technique. In light of a complication rate of up to 17%, selective use of K-wire fixation in uncomplicated closed fractures should only be considered in children over the age of 10 years in fractures with complete displacement where anatomical reduction cannot be achieved.

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Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature

Cited by 19 publications

References 17 publications

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Treatment of distal radius metaphyseal fractures in children: a case report and literature review

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