Distal Radius Fractures in Childhood - Our Five-Year Experience

Abstract

The most common fractures in children are those of the distal radius. There are relatively scanty publications devoted to this specific pathology in childhood. The timely diagnosis and proper treatment of the distal radius fractures are of undoubted significance. The purpose of the present communication is to share our recent practical experience with the management of the distal radius fractures in children. 2. Methodology. During the period between January 1, 2017 and December 31, 2021, 34 children at an average age of 10,85±3,00 years (between two and 17) with wrist joint injuries resulting in distal radius fractures were examined in the Clinic of Orthopedics and Traumatology, St. Anna Multiprofile Hospital of Varna. There were 21 boys at an average age of 11,43±3,39 years (between two and 17) and 13 girls at an average age of 9,92±2,38 years (between six and 12). Diagnosis was based on clinical and x-ray examinations. Therapeutic behavior included operative treatment, administration of analgesic means, immobilization, and, in some cases, subsequent rehabilitation. Surgery was accomplished under general anaesthesia in most cases. 3. Results. Mean age did not differ statistically reliably between both groups (t=1,524; p>0,05). The left radius fractures (13 in boys and 11 in girls) were statistically significantly more common than right radius ones (eight in boys and two in girls) (t=3,726; p<0,001). Most commonly, a closed reduction technique with or without internal fixation of the radius and ulna was made use of (in 15 boys and in seven girls) followed by reposition and fixation with one Kirschner wire (in one girl), with two Kirschner wires (in five boys and one girl), or with three ones (in five boys and two girls). An open reduction technique was applied in six boys and in six girls followed by reposition and fixation with one Kirschner wire (in one girl), with two Kirschner wires (in two boys and two girls), or with three ones (in two boys). It should be noted that internal fixation was not carried out in two boys and three girls. Control x-ray examination was performed in all the children. Cast immobilization for a period between 28 and 35 days, most often, for one month, was obligatorily done. Subsequently, Kirschner wires were removed in eight boys and in four girls. One complication was observed in a six-year old girl. It was caused by mechanical damage of the left wrist joint following the implantation of the internal orthopedic devices, i.e. three Kirschner wires. They were removed two months after the operation. Complete healing was achieved in all the children. 4. Conclusions. Based on these results of ours, the conclusion can be drawn that these surgical procedures along with the precise diagnosis and immobilization have proven to be safe and effective in the children with distal radius fractures. Obviously, modern strategies to successfully prevent the fractures in children should be developed.