Most surgeons still prefer to reduce overriding distal radius fractures in children

Laaksonen, Topi; Puhakka, Jani; Kosola, Jussi; Stenroos, Antti; Ahonen, Matti; Nietosvaara, Yrjänä

doi:10.1080/17453674.2020.1854502

Cited by 6 publications

(6 citation statements)

References 17 publications

(51 reference statements)

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“…However, a recent survey suggested that most European and American surgeons still prefer to reduce these fractures, even in prepubescent children 22 . Furthermore, treatment and follow-up protocols seem to vary substantially 22 . We found a substantial variation in treatment decisions made by individual surgeons in our hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to this traditional thinking, Crawford et al 20 reported good outcomes in patients <11 years old with completely displaced overriding distal metaphyseal radial fractures immobilized in an overriding position without reduction. In recent surveys, most surgeons still prefer reduction 21,22 . Quality standards for treatment of these fractures have not yet been established.…”

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confidence: 99%

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Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents

Laaksonen

Kosola

Nietosvaara

et al. 2021

Journal of Bone and Joint Surgery

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Background:The incidence of completely displaced overriding distal metaphyseal radial fractures in children is unknown, and the optimal treatment is controversial.Methods:All completely displaced distal metaphyseal radial fractures in patients <16 years old treated in our tertiary-level institution from 2014 to 2019 were identified with use of the Kids’ Fracture Tool Helsinki. Etiology, fracture characteristics, management, and quality of treatment were assessed. A telephone interview with the guardian of the patient was performed for 100 (89%) of 112 patients at 1.5 to 7.2 years (median, 4.6 years) after the injury. Pain during the last month and forearm function were recorded. Treatment satisfaction was assessed with use of a 7-point Likert scale.Results:A total of 113 completely displaced overriding distal metaphyseal radial fractures in 112 patients (81 of whom were residents of Helsinki) were treated during the 6-year-long study period. The mean annual incidence was 1.42 per 10,000 population. Most (73%) of these fractures occurred in children <11 years old, and most fractures were dorsally displaced and located nearly as far proximally from the distal radial physis as the maximum width of the distal metaphysis. Closed manipulation was attempted in two-thirds of cases in the emergency department, with a failure rate of 46%. Strong opioids were administered in 70 of 112 patients. None of the 26 patients whose fractures were immobilized in an overriding position had secondary interventions, pain, or functional disability. The mean satisfaction with treatment on the Likert scale was 6.2.Conclusions:The annual incidence of overriding distal metaphyseal radial fractures patients <16 years old was shown to vary between 0.72 and 2.01 per 10,000 population. Opioids, local and general anesthesia, hospital admission, and secondary interventions can be avoided in prepubescent patients by casting these fractures in an overriding position while the patient is in the emergency department.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents

Laaksonen

Kosola

Nietosvaara

et al. 2021

Journal of Bone and Joint Surgery

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“…This is not surprising, as the most common fracture type was a simple stable torus fracture. Casting only is considered a less favorable option for complete fractures, since it is thought to be insufficient [ 1 , 3 , 10 , 16 , 17 ] and carries a greater risk of redislocation and other complications, such as malunion [ 1 , 3 , 17 ]. It has been reported that adequate reduction before casting is crucial to prevent redislocation [ 6 , 12 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Distal radius fractures in children aged 5–12 years: a Swedish nationwide register-based study of 25 777 patients

Bergkvist

Lundqvist

Pantzar-Castilla

2023

BMC Musculoskelet Disord

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Background Distal radius fracture (DRF) is the most common type of fracture in children. There is no clear consensus on primary treatment for complete DRFs. Kirschner wire (K-wire) fixation has been recommended, to avoid the risk of redislocation. However, recent studies have indicated that casting can be sufficient, at least for children with two or more years left to grow. There is no recent study regarding pediatric DRFs and the extent of K-wire fixations in the Swedish population. The purpose of this study was to investigate epidemiology and treatment of pediatric DRFs registered in the Swedish Fracture Register (SFR). Methods In this retrospective study, based on data from SFR for children aged 5–12 years with DRF between January 2015 and October 2022, we investigated epidemiology and choice of treatment. Sex, age, type of DRF, treatment, cause and mechanism of injury, were analyzed. Results In total, 25,777 patients were included, 7,173 (27%) with complete fractures. Number and peak age of girls vs. boys with fractures were 11,742 (46%), 10 years, and 14,035 (54%), 12 years, respectively. Odds ratio (OR) for a K-wire fixation in girls vs. boys was 0.81 (95% confidence interval (CI) 0.74–0.89, p < .001). With age 5 -7 years as reference, OR for age group 8–10 years was 0.88 (95% CI 0.80–0.98 p = .019) and OR for age group 11–12 years was 0.81 (95% CI 0.73–0.91 p = < .001. Conclusion Casting only was the preferred treatment for all fractures (76%). Boys acquired DRFs more often than girls, with a peak age of 12 years. Younger children and boys with a complete fracture were more likely than older children and girls to receive a K-wire. Further research regarding indications for K-wiring of DRFs in the pediatric population is needed.

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“…The rationale behind this meta-analysis was that there is a significant lack of agreement on the indications of cast type application regarding the treatment of displaced distal forearm fractures in pediatric patients. [26][27][28][29] In a survey, Laaksonen et al 27 reported possible overtreatment and practice variation for treatment of completely displaced distal radius fractures in pediatric patients. In this survey, the majority of surgeons (84% of 213 participating surgeons) chose an AEC to immobilize distal forearm fractures, although earlier reports showed that AEC does not retain the alignment of displaced distal forearm fractures in children any better than BEC.…”

Section: Discussionmentioning

confidence: 99%

Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials

Alzobi

Hantouly

Kenawey

et al. 2023

Journal of Children's Orthopaedics

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Objectives: Distal forearm fractures are the most common pediatric fractures. This study aimed to investigate the effectiveness of below-elbow cast treatment for displaced distal forearm fractures in children compared to above-elbow cast through meta-analysis of randomized controlled trials. Methods: Several databases from January 1, 2000 until October 1, 2021 were searched for randomized controlled trials that assessed below versus above-elbow cast treatment of displaced distal forearm fractures in pediatric patients. The main meta-analysis comparison was based on the relative risk of loss of fracture reduction between children undergoing below versus above-elbow cast treatment. Other outcome measures including re-manipulation and cast-related complications were also investigated. Results: Nine studies were eligible of the 156 articles identified, with a total of 1049 children. Analysis was undertaken for all included studies with a sensitivity analysis conducted for studies with high quality. In the sensitivity analysis, the relative risks of loss of fracture reduction (relative risk = 0.6, 95% confidence interval = 0.38, 0.96) and re-manipulation (relative risk = 0.3, 95% confidence interval = 0.19, 0.48) between the below and above-elbow cast groups were in favor of below-elbow cast and statistically significant. Cast-related complications were in favor of below-elbow cast but did not attain statistical significance (relative risk = 0.45, 95% confidence interval = 0.05, 3.99). Loss of fracture reduction was noted in 28.9% of patients treated with above-elbow cast and 21.5% in below-elbow cast. Re-manipulation was attempted in 48.1% versus 53.8% of children who lost fracture reduction in the below-elbow cast and above-elbow cast groups, respectively. Conclusion: Below-elbow cast treatment was favored, with statistical significance, in terms of loss of fracture reduction and re-manipulation, and was not associated with a higher risk of cast-related complications. The accumulative evidence currently does not support above-elbow cast treatment and below-elbow cast treatment should be the mainstay for displaced distal forearm fractures in children. Level of evidence: Level I, meta-analysis of therapeutic level I studies.

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Most surgeons still prefer to reduce overriding distal radius fractures in children

Cited by 6 publications

References 17 publications

Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents

Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents

Distal radius fractures in children aged 5–12 years: a Swedish nationwide register-based study of 25 777 patients

Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials

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