Displaced fracture of the distal radius in children

Zamzam, Mohammed M.; Khoshhal, Khalid I.

doi:10.1302/0301-620x.87b6.15648

Cited by 128 publications

(76 citation statements)

References 12 publications

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“…Perfect anatomical reduction is one of the most widely accepted factors preventing re-displacement (Proctor et al. 1993, Zamzam and Khoshhal 2005). In line with earlier studies (Voto et al.…”

Section: Discussionmentioning

confidence: 99%

“…1993, McLauchlan et al. 2002, Zamzam and Khoshhal 2005, Alemdaroglu et al. 2008), but much less data are available regarding predictors for re-displacement of diaphyseal fractures (Colaris et al.…”

Section: Discussionmentioning

confidence: 99%

“…30% of our patients had a single bone fracture, which might reduce the need for initial re-manipulation and is protective against re-displacement. Both-bone forearm fracture is associated with a higher probability of incomplete reduction and re-displacement (Zamzam and Khoshhal 2005, Hang et al. 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Much of the recent literature on forearm fractures has focused on the rate of re-displacement after closed reduction and immobilization of distal metaphyseal radius fractures (Mani et al. 1993, Zamzam and Khoshhal 2005, Alemdaroglu et al. 2008), but there are limited data on the outcome of diaphyseal forearm fractures in children (Kay et al.…”

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confidence: 99%

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

2016

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

2016

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“…Closed treatment, however, has a reported 7–34% redisplacement, requiring secondary reduction procedure [2, 6–8, 17]. Proctor et al even found a 73% of redisplacement in completely displaced fractures when reduction was imperfect [6].…”

Section: Discussionmentioning

confidence: 99%

Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated

Egmond

Schipper

Luijt

2011

Eur J Orthop Surg Traumatol

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PurposeWorldwide, many displaced distal forearm fractures in children are treated by closed reduction under local anesthesia and cast immobilization. If mal-alignment of the fracture persists after initial reduction attempt, final fracture reduction will be performed under general anesthesia, followed by cast immobilization. The purpose of this study was to analyze the results of minimally invasive fixation with K-Wire or ESIN after fracture reduction in children under general anesthesia, compared with the results of closed reduction and plaster immobilization. We hypothesize that primary percutaneous fixation prevents secondary redisplacement and reduces the number of secondary interventions.MethodsAll skeletally immature children who sustained a distal forearm fracture, and treated under general anesthesia in the operation room (OR), were included. The patients were analyzed according to three treatment groups and fracture type. The primary outcome measure was the number of patients who required a second procedure of fracture reduction after initial treatment.ResultsA considerable amount of children with displaced distal forearm fractures treated by closed reduction and cast immobilization show loss of reduction and require secondary reduction (43.7%). After closed reduction with primary internal fixation, with minimally invasive techniques such as K-wires or ESIN, secondary loss of reduction did not occur.ConclusionsAdditional internal fixation after reduction of a forearm fracture minimizes the secondary displacement risk and the subsequent risk of a re-intervention. Therefore, primary minimal invasive fixation of displaced distal forearm fractures after closed reduction under general anesthesia seems preferable to closed reduction only and is strongly recommended as the preferred treatment strategy.

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Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

et al. 2020

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IMPORTANCE Improvement of clinician understanding of acceptable deformity in pediatric distal radius fractures is needed. OBJECTIVE To assess how often children younger than 10 years undergo a potentially unnecessary closed reduction using procedural sedation in the emergency department for distal radial metaphyseal fracture and the associated cost implications for these reduction procedures. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included 258 consecutive children younger than 10 years who presented to a single, level I, pediatric emergency department and who had a distal radius fracture with or without ulna involvement between January 1, 2016, and December 31, 2017. Reductions were deemed to be potentially unnecessary if the coronal and sagittal plane angulation of the radius bone measured less than 20°and shortening measured less than 1 cm on initial injury radiographs. Use of procedural sedation or transfer status to another facility was noted if present. Statistical analysis was performed from April 2019 to June 2019. MAIN OUTCOMES AND MEASURES Potentially unnecessary reduction was the primary outcome. Radiographic findings were measured to determine reduction necessity. Additional variables measured were age, sex, time in the emergency department, transfer status, required reduction procedure, use of sedation, and cost associated with care. RESULTS Of the 258 participants studied, 156 (60%) were male, with a mean (SD) age of 6.7 (2.3) years. Among 142 patients (55%) who underwent closed reduction with procedural sedation in the emergency department, 38 (27%) procedures were determined to be potentially unnecessary. Review of Common Procedural Terminology charges revealed an approximately $7000 difference between the stated cost of a reduction procedure in the emergency department vs a cast application in an outpatient orthopedic clinic for distal radial metaphyseal fractures. The mean (SD) maximal angulation in either plane for fractures that underwent appropriate reduction was 30.6°(10.3°) compared with 13.9°(4.5°) for those unnecessarily reduced (P < .001). Patients who were transfers from other facilities were more than twice as likely to undergo a potentially unnecessary reduction (odds ratio, 2.3; 95% CI, 1.1-5.0; P = .03). CONCLUSIONS AND RELEVANCE The findings suggest that improved awareness of these acceptable deformities in young children may be associated with limiting the number of children requiring reduction with sedation, improving emergency department efficiency, and substantially reducing health care costs.

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Displaced fracture of the distal radius in children

Cited by 128 publications

References 12 publications

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

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

Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated

Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

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