Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively?

Vescio, Andrea; Testa, Gianluca; Sapienza, Marco; Caldaci, Alessia; Montemagno, Marco; Andreacchio, Antonio; Canavese, Federico; Pavone, Vito

doi:10.3390/children9030425

Cited by 8 publications

(7 citation statements)

References 39 publications

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“…The distribution of anatomic locations of physeal fractures for long bones of the appendicular skeleton has been explored as well, with most fractures occurring in the upper extremities, especially of the radius [ 1 , 3 , 5 ]. This observation has led to outcomes research analyzing the treatment of these fractures, such as outcomes based on body habitus [ 6 ]. Fractures that involve the physis are classified according to the Salter–Harris (SH) classification system, which grades fractures according to the involvement of the physis, metaphysis, and epiphysis ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of Physeal Fractures from the United States National Trauma Data Bank

et al. 2022

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Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation.

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Section: Introductionmentioning

confidence: 99%

Analysis of Physeal Fractures from the United States National Trauma Data Bank

et al. 2022

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“…Some studies have reported that obese children are more likely to sustain an upper extremity fracture than nonobese children from ground-level falls [ 14 - 16 ]. In addition, one study reported that obese children have a higher rate of loss of fracture reduction than that healthy-weight children [ 17 - 19 ]. In the current study, only two of the 16 (12.5%) patients were overweight, and three (18.75%) were obese [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The Slipper Fracture: Revisited

Álvarez¹,

Chen²,

Pilla³

et al. 2023

Cureus

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Objectives The term “slipper fracture” is used to describe a fracture of the radius at the junction of the metaphysis and diaphysis. This fracture has an “evil” reputation because it often angulates in the cast. Historically, there have been differing opinions on the optimal way to cast slipper fractures either with a long arm cast in pronation or a long arm cast in supination to prevent angulation. The purpose of this study is to report the outcomes of “slipper fractures” treated with casting. Methods Sixteen slipper fractures were retrospectively reviewed. Electronic medical records (EMRs) and radiographs were analyzed to gather data on body weight, cast type, cast position, cast index, loss of reduction, cast wedging, repeat reduction, surgery, and amount of remodeling. Results The average age of the patients was eight years old. The average body weight was 30.4 kg. Initial casting included 14 long arm casts in neutral, one short arm cast, and one sugar tong splint. The average cast index was 0.87. Only one cast had a cast index of less than 0.8. This fracture was treated with a long arm cast and did not displace. Of the fractures, 94% lost reduction in the cast and angulated an average of 26 degrees. Two cases were treated with a cast wedge; 13 were observed. Remodeling occurred at an average rate of 2.7 degrees/month. The average remodeling measured at the last follow-up was 15 degrees. Conclusion Slipper fractures are difficult to treat due to the angulation of the fracture in the cast. The current study indicates that a long arm cast, appropriate cast index, and cast position are key to preventing the loss of reduction or angulation of a slipper fracture.

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“…In 189 children under 16 years of age with displaced distal radius fractures undergoing conservative treatment, there are statistically significant differences between normal weight and obese patients in terms of the number of the loss of reduction (p=0,002), severity of initial translation (p=0,008) and quality of initial reduction (p=0,01) (Vescio et al, 2022). Among 176 children with fractures of the distal radius treated in the Emergency Department of the Bahrain Defense Force Hospital during a retrospective cohort study from January 1, 2015, to February 1, 2022, 77 patients are conservatively managed with cast immobilization while 99 are surgically managed -56 with percutaneous pinning or 43 flexinail (Aladraj et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Distal Radius Fractures in Childhood - Our Five-Year Experience

Staykov¹,

Kolarov²

2022

IJMSR

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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.

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Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively?

Cited by 8 publications

References 39 publications

Analysis of Physeal Fractures from the United States National Trauma Data Bank

Analysis of Physeal Fractures from the United States National Trauma Data Bank

The Slipper Fracture: Revisited

Distal Radius Fractures in Childhood - Our Five-Year Experience

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