Management of Distal Radius Fractures in Adolescent Patients

Greig, Danielle; Silva, Maurício

doi:10.1097/bpo.0000000000001778

Cited by 16 publications

(11 citation statements)

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“…Owing to rapid healing and robust remodeling potential in children, nonoperative treatment with closed reduction and casting is the preferred initial treatment. 19 Nevertheless, the variability and percentage of patients experiencing LOR after undergoing nonoperative treatment (ranging from 8% to 23%) indicates an opportunity to better understand this problem. 5 Initial CRPP is one alternative, but risks such as infection and growth arrest with pins crossing the physis have been reported and, therefore, must be taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

“…Reduction was considered satisfactory when the residual angulation was less than 15 degrees in patients 10 years of age and younger and less than 10 degrees in children older than 10 years of age, as has been generally accepted in the literature. 19 Once appropriate reduction was achieved, a sugar-tong splint was applied with the forearm in neutral position. Per institutional protocol, reduction was considered acceptable if a cast index of less than 0.8 was demonstrated.…”

Section: Introductionmentioning

confidence: 99%

“…16 Pinning has risks including pin track infection, and, rarely, physeal bar formation with pins crossing the growth plate. 17,18 Much of the current literature on risk factors and treatment of lost reduction in distal radius fractures focuses on extraphyseal fractures of the metaphysis, 19 with few studies analyzing physeal fractures. One study reported redisplacement in 12 of 157 physeal fractures, with 7 requiring remanipulation and none requiring pinning.…”

Section: Introductionmentioning

confidence: 99%

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Distal Radius Salter–Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children

Rivera

Welbeck

Cummings

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To assess factors affecting the loss of reduction (LOR) in a large cohort of children with Salter–Harris Type II (SH II) distal radius physeal fractures treated with closed reduction. Design: Retrospective chart review. Setting: Pediatric Level I Trauma Center. Patients/Participants: A total of 141 pediatric patients (73% male, average age: 12.15 ± 2.55 years) that had undergone closed reduction and casting for distal radius physeal fractures from 2006 to 2019 were included in this study. Intervention: Closed reduction and casting. Main Outcome Measurements: Five different radiographic measurements were analyzed at 4 different time points. Follow-up radiographs were assessed in relation to initial reduction. LOR was defined as >5 degrees change of angulation on PA radiographs, >10 degrees change of angulation on lateral radiographs, and/or >25% translation on PA or lateral radiographs. Results: LOR was seen in 28.4% of the patients, most often (68%) in the first 2 weeks after initial reduction. Seven (17.5%) of these patients (average age: 15.2 ± 2.0 years) were treated surgically with closed reduction and percutaneous pinning (CRPP). Patients undergoing CRPP for LOR were an average of 3.4 years older (P < 0.001) than those who underwent nonoperative treatment of LOR. Patients with initial angulation more than 5 degrees on the PA view to be twice as likely to have LOR (P = 0.03). Conclusions: LOR was seen in nearly 1/3 of these patients. Patients with initial higher degree of angulation on the coronal plane are at higher risk for LOR. Age, not the degree of angulation, is the main predictor for potential surgical treatment. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distal Radius Salter–Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children

Rivera

Welbeck

Cummings

et al. 2023

Journal of Orthopaedic Trauma

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“…The re-displacement of distal radius fracture in children can be a result of several factors including, initial complete displacement, degree of obliquity of the fracture, and an association of ulnar fracture when distal radius fracture is managed conservatively. Therefore, percutaneous pinning is suggested for children with a high risk of re-displacement of distal radius fractures who are managed conservatively [ 13 , 14 ]. On the other hand, the surgical intervention was found to be commonly associated with superficial pin-site infection.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children

Aladraj¹,

Keshta²,

Mukhtar³

et al. 2022

Cureus

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Distal radius fractures are common pediatric orthopedic injuries accounting for 25% of all fractures with a significant incidence in the age group 10-14 years. This study aims to evaluate the operative and nonoperative methods of treating distal radius fractures in children. MethodsThis is a retrospective cohort study conducted on 176 children with distal radius fracture. We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022. The inclusion criteria were as follows: age of 17 years or younger, distal radius fracture with or without complete displacement and skeletal immaturity managed as of non-operative or operative groups. Patients who did not have follow-up data after the date of surgery were excluded. The statistical analysis was performed using the software SPSS version 23.0 (IBM Corp., Armonk, NY). Continuous data expressed as mean, standard deviation and discrete variables were expressed as frequency and percentages. One-way Analysis of Variance (ANOVA) was used to compare the continuous variables between groups. The Student's t-test was used for the two-group comparison. For the comparison of discrete variables, a Chi-Square test or Fisher's exact test was used. ResultsSeventy-seven patients were conservatively managed with cast immobilization ("non-operative" group) in comparison to 99 patients who were surgically managed ("operative" group) with either percutaneous pinning (n=56) or flexinail (n=43). Fewer patients underwent physiotherapy in the operative group with 14 (25.0%) patients for percutaneous pinning and seven (16.3%) patients for flexinail versus 31 (40.3%) patients in the non-operative group (p<0.015). There were statistically significant differences in radial inclination (p<0.001) between conservative and percutaneous pinning (22.22±2.86 vs 18.76±3.33 degrees) and percutaneous pinning and flexinail (18.76±3.33 vs 22.37±3.44 degrees). Likewise, there was a significant difference found in ulnar variance between conservative and percutaneous pinning (-0.45±2.14 mm vs -1.47±1.93 mm, p=0.012) and conservative and flexinail (-0.45±2.14 mm vs -1.59±1.90 mm, p=0.009). There were a total of 25 documented complications. Nineteen (19.8%) complications occurred in the non-operative group versus five (7.2%) and one (2.3%) complications in percutaneous pinning and flexinail groups, respectively (p=0.003). The most common complication in the non-operative group was loss of reduction while in cast and subsequent need for surgical intervention. Ten of these patients underwent percutaneous pinning whereas nine were fixed by flexinail. ConclusionThis study illustrated an overall similar success between the surgical and the conservative treatments of distal radius fractures in children. Due to the higher complication rate reported in the conservative group, the conservative treatment cannot be considered safer than the surgical treatment.

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“…The low incidence rate of adult fractures leads to few epidemiological studies. The treatment of both bone forearm fractures in children is mainly conservative ( 7 , 8 ). For cases with obvious fracture displacement, surgical treatment is usually used.…”

Section: Discussionmentioning

confidence: 99%

Hybrid fixation with ESIN for both bone forearm fractures in adults: A case report and literature review

Bai

Liu²,

Chen³

et al. 2022

Front. Surg.

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ObjectiveBoth bone forearm fractures are common in children and rare in adults. The main surgical treatment is open reduction and internal fixation (ORIF) with plate, while the hybrid fixation of elastic-stable intramedullary nailing (ESIN) and the plate has been rarely reported before.Case reportWe report a case of a 29-year-old male patient with both bone forearm fractures. Temporarily closed reduction and plaster external fixation were performed in the emergency room, and the patient was admitted to the orthopedic trauma ward for surgery. The patient underwent open reduction and plate fixation of the ulna and closed reduction and ESIN fixation of the radius. The fractures healing was satisfactory and the internal fixation was removed 12 months postoperatively.ConclusionThe hybrid fixation of ESIN and plate is an effective option for both bone forearm fractures in adults.

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Management of Distal Radius Fractures in Adolescent Patients

Cited by 16 publications

References 50 publications

Distal Radius Salter–Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children

Distal Radius Salter–Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children

A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children

Hybrid fixation with ESIN for both bone forearm fractures in adults: A case report and literature review

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