Risk Factors for Redisplacement of Pediatric Distal Forearm and Distal Radius Fractures

McQuinn, Alexander; Jaarsma, Ruurd L.

doi:10.1097/bpo.0b013e31824b7525

Cited by 72 publications

(67 citation statements)

References 18 publications

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“…18,[24][25][26] The 3-point index is argued to be the most predictive radiographic measure of late displacement after closed reduction and casting of pediatric DR fractures, with other risks for loss of forearm fracture reduction including a cast index of >0.7, incompletely reduced fractures (ie, residual displacement and/or angulation after manipulation), degree of initial fracture displacement/obliquity (bayonet apposition, >50% translation, and >30 degrees angulation), muscle atrophy, and resolution of initial soft-tissue swelling while in the cast. 24,25,[27][28][29][30] Our cohort included 70 patients of varying ages and fracture patterns treated by residents ranging in years from PGY-1 to PGY-5. There was variability in the amount of fracture displacement, translation, and cast indices, but improvement of angulation in all but 1 patient after cast wedging was observed.…”

Section: Discussionmentioning

confidence: 99%

Is There Still a Place for Cast Wedging in Pediatric Forearm Fractures?

Samora

Klingele

Beebe

et al. 2014

Journal of Pediatric Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Is There Still a Place for Cast Wedging in Pediatric Forearm Fractures?

Samora

Klingele

Beebe

et al. 2014

Journal of Pediatric Orthopaedics

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“…Rates of redisplacement have been reported to be between 7 and 91 % [3]. A previous study revealed a re-displacement rate of 21.3 % at our institute [4]. In case of re-displacement, especially re-angulation, the clinician is often confronted with a treatment dilemma: whether to perform a remanipulation or to accept re-displacement and trust on correction by growth [3].…”

Section: Introductionmentioning

confidence: 94%

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Roth

Denk

Colaris

et al. 2014

Arch Orthop Trauma Surg

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Re-manipulation of distal forearm fractures in children <12 years did not improve outcomes, deeming re-manipulations unnecessary. Children ≥12 years in the conservative group achieved satisfactory outcomes despite re-angulations exceeding current guidelines. Based on observed remodelling, we now accept up to 30° angulation in children <9 years; 25° angulation in children aged 9-<12; 20° angulation in children ≥12 years, when re-angulation occurs. We conclude that clinicians should be more reluctant to perform re-manipulations.

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“…For substantially displaced paediatric distal radius fractures, fracture reduction and cast immobilization is often the treatment of choice. Recent studies showed, however, that redisplacement rates are considerable and range from 21 to 39% after conservative treatment [5][6][7][8][9]. To prevent redisplacement after reduction, the fracture can be fixated with K-wires.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Sengab

Krijnen

Schipper

2019

Eur J Trauma Emerg Surg

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Purpose Displaced distal radius fractures in children are common and often reduced if necessary and immobilized in cast. Still, fracture redisplacement frequently occurs. This can be prevented by fixation of fracture fragments with K-wires, but until now, there are no clear guidelines for treatment with primary K-wire fixation. This meta-analysis aimed to identify risk factors for redisplacement after reduction and cast immobilization of displaced distal radius fractures in children, and thereby determine which children will benefit most of primary additional K-wire fixation. Methods Eight databases were searched to identify studies and extract data on the incidence of and risk factors for redisplacement of distal radius fractures after initial reduction and cast immobilization in children. Results Twelve studies, including 1256 patients, showed that initial complete displacement (odds ratio [OR] 4.69, 95% confidence interval [CI] 2.98-7.39) and presence of a both-bone fracture (OR 1.95, 95% CI 1.34-2.85) were independent risk factors for redisplacement. Anatomical reduction reduced the redisplacement risk (OR 0.14, 95% CI 0.05-0.40). No significant influence on redisplacement risk could be established for female sex, experience level of the attending surgeon, Cast Index < 0.8, Three-Point Index < 0.8 and patient's age. Conclusions For children with a displaced distal radius fracture, the presence of a both-bone fracture, complete displacement of the distal radius and non-anatomical reduction are risk factors for redisplacement after reduction of their initially displaced distal radius fracture. Children with one or more of these risk factors probably benefit most of reduction combined with primary K-wire fixation.

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Risk Factors for Redisplacement of Pediatric Distal Forearm and Distal Radius Fractures

Abstract: Level II--Retrospective prognostic study.

Cited by 72 publications

References 18 publications

Is There Still a Place for Cast Wedging in Pediatric Forearm Fractures?

Is There Still a Place for Cast Wedging in Pediatric Forearm Fractures?

Think twice before re-manipulating distal metaphyseal forearm fractures in children

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

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