Principles of fracture remodeling in children

Wilkins, Kaye E.

doi:10.1016/j.injury.2004.12.007

Cited by 150 publications

(96 citation statements)

References 15 publications

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“…This phenomenon is well established in pediatric and long bone fractures; however it has not been previously reported in the healing of scaphoid nonunions [4].…”

Section: Discussionmentioning

confidence: 89%

A Qualitative Evaluation of Scaphoid Remodeling in Bone-Grafted Scaphoid Nonunions

Grewal

Boyd

MacDermid

et al. 2010

Hand (New York, N,Y.)

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The purpose of this case series is to identify and illustrate the phenomenon of scaphoid remodeling in skeletally mature subjects following bone grafting for scaphoid nonunion. Nine patients with scaphoid nonunions were treated with interpositional bone grafting (with iliac crest bone graft) and K-wire fixation. The mean length of follow-up was 28.6±9 months. Radiographs and CT scans were reviewed and assessed for degree of union and a qualitative assessment of scaphoid architecture. Following surgery, there was marked distortion of the scaphoid. Once healed, the contour of the scaphoid was still significantly distorted in all nine patients. Remodeling then became evident along the articular surfaces between 8 and 12 months. By 3 years, the scaphoid was completely recontoured and the normal architecture was completely restored in all nine patients. We conclude that the articular surface of the scaphoid remodels over time in skeletally mature subjects.

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“…This phenomenon is well established in pediatric and long bone fractures; however it has not been previously reported in the healing of scaphoid nonunions [4].…”

Section: Discussionmentioning

confidence: 89%

A Qualitative Evaluation of Scaphoid Remodeling in Bone-Grafted Scaphoid Nonunions

Grewal

Boyd

MacDermid

et al. 2010

Hand (New York, N,Y.)

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“…3,4,6 The safe use of a splint for fractures with an excellent long-term prognosis has implications for management of these injuries. Given that the splint can be applied or taken off easily by any health care provider and does not require the specialized services of an orthopedic technologist or surgeon allows for definitive treatment of these injuries during the first patient encounter in an emergency department or urgent care clinic rather than during a separate visit at a fracture clinic.…”

Section: Discussionmentioning

confidence: 99%

“…The splint obviates the technical challenges and associated potential complications 7,29 that may be an issue with those less skilled in the placement of casts. Further, the rarity of complications that require surgical intervention 3,4,6 for either immobilization device minimizes the need for what is often weekly follow-up with an orthopedic surgeon. 1,3 Limitations Our study has limitations.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] These minimally angulated fractures generally do not require reduction, have an excellent long-term prognosis and rarely result in complications such as malunion or deformity. 3,5,6 The mainstay of treatment for these fractures has been the use of a short arm cast for four to six weeks and several follow-up visits to an orthopedic surgeon. 3,5 However, a cast complicates hygiene for a child, and there may be risks that result from a poor fit.…”

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confidence: 99%

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Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

Boutis¹,

Willan²,

Babyn³

et al. 2010

Canadian Medical Association Journal

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“…2,7 Nevertheless, healing of these more complex injuries is excellent because the distal radius has one of the highest capacities for remodeling. 25 An intervention by an orthopedic surgeon is rarely required, [25][26][27] and these fractures can generally be safely treated by using a splint. However, these injuries may require longer immobilization and different anticipatory guidance.…”

Section: Figurementioning

confidence: 99%

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

Koelink

Schuh²,

Howard³

et al. 2016

Pediatrics

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OBJECTIVES: Our main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.METHODS: This prospective cohort study was conducted at a tertiary care pediatric emergency department (ED). Eligible children were aged 2 to 17 years with a distal radius buckle fracture treated with a removable splint and referred to the PCP for reassessment. We telephoned families 28 days after their ED visit. The primary outcome was the proportion who received PCP follow-up exclusively. We also measured the proportion who received PCP anticipatory guidance and those children who reported returning to usual activities "always" by 4 weeks. RESULTS:We enrolled 200 children, and 180 (90.0%) received telephone follow-up. Of these, 157 (87.2% [95% confidence interval: 82.3 to 92.1]) received PCP follow-up exclusively. Specifically, 11 (6.1%) families opted out of physician follow-up, 5 (2.8%) self-referred to an ED, and the PCP requested specialty consultation in 7 (3.9%) cases. Of the 164 with a PCP visit, 77 (47.0%) parents received anticipatory guidance on return to activities for their child, and 162 (98.8%) reported return to usual activities within 4 weeks. CONCLUSIONS:The vast majority of children with distal radius buckle fractures presented to the PCP for follow-up and did not receive additional orthopedic surgeon or ED consultations. Despite a suboptimal rate of PCP advice on return to activities, almost all parents reported full return to usual activities within 4 weeks.

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Principles of fracture remodeling in children

Cited by 150 publications

References 15 publications

A Qualitative Evaluation of Scaphoid Remodeling in Bone-Grafted Scaphoid Nonunions

A Qualitative Evaluation of Scaphoid Remodeling in Bone-Grafted Scaphoid Nonunions

Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

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