Risk Factors in Redisplacement of Distal Radial Fractures in Children

Alemdaroğlu, Kadir Bahadır; İltar, Serkan; Çimen, Oğuzhan; Uysal, Mehmet Ali; Alagöz, Ender; Atlıhan, Doğan

doi:10.2106/jbjs.g.00624

Cited by 134 publications

(177 citation statements)

References 9 publications

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“…Previous studies on this fracture type have shown that initial displacement [8-11, 15, 16], failure to achieve a complete reduction [8,10,13,17], distal radius fracture with or without an ulna fracture [9,11,17,18], age [19], obliquity of the fracture [8,9] and poor casting [8] are significant risk factors for loss of reduction in this age group.…”

Section: Discussionmentioning

confidence: 99%

“…According to Alemdaroglu et al [8], an incompletely reduced fracture is five times more likely to re-displace than those anatomically reduced. Roy et al [17] reported that fractures reduced to less than 50% apposition required re-manipulation more frequently.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have reported good outcomes with non-operative management with few complications or long-term problems [7]; however, other authors have reported loss of reduction rates between 10% and 91%. In general, up to one third of cases will demonstrate late displacement [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Factors leading to re-displacement have been reported in the literature and can be broadly divided into three groups: (1) Fracture-related factors such as initial displacement, and increased obliquity of the fracture line [8,10,11]; (2) Treatment-related factors such as residual angulation after initial reduction and poor casting technique [10]; and (3) Patient-related factors such as muscle atrophy and resolution of initial soft tissue swelling while in the cast [5].…”

Section: Introductionmentioning

confidence: 99%

“…Some recent reports have advocated the routine use of percutaneous pin fixation as the initial treatment of high risk fractures [8,9]. The aim of this study was to identify those fractures with a high risk of re-displacement and analyse the associated potential risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Mazzini

Beck

Brewer

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to identify factors which contribute to loss of reduction (LOR). Methods Outpatient records and initial, post-reduction (PR) and follow-up radiographs of patients with a distal radial metaphyseal fracture were reviewed to determine demographic factors; fracture characteristics (obliquity, comminution, intact ulna); three-point cast index (3PI); and initial, PR, and follow-up displacement (angulation and translation in the sagittal and coronal planes). Univariate and multivariate regression were used to identify significant risk factors for LOR. Results A total of 161 patients were included in our series (119 boys and 42 girls). Fifty-seven (35%) patients met the criteria for LOR. Multivariate logistic regression revealed that patients over 14 years old were 4.8 times more likely (p00.01) to lose reduction, and those with more than 10% PR translation in the sagittal plane were four times more likely (p00.03) to lose reduction. In younger patients, initial coronal translation and PR sagittal translation were independent risk factors. Patients with over 10% initial translation in the coronal plane were 2.4 times more likely (p00.01) to lose reduction, and those with over 10% PR translation in the sagittal plane were 2.7 times more likely (p00.03) to lose reduction. Three point cast index was not found to be a significant risk factor (1.64 vs. 1.57, p00.43).Conclusion Our study, the largest dedicated series of distal radial metaphyseal fractures, indicates that loss of reduction is common. Our analysis suggests that an anatomical reduction, which minimises residual translation, is the most important variable in preventing a loss of reduction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Mazzini

Beck

Brewer

et al. 2012

International Orthopaedics (SICOT)

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Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

et al. 2020

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IMPORTANCE Improvement of clinician understanding of acceptable deformity in pediatric distal radius fractures is needed. OBJECTIVE To assess how often children younger than 10 years undergo a potentially unnecessary closed reduction using procedural sedation in the emergency department for distal radial metaphyseal fracture and the associated cost implications for these reduction procedures. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included 258 consecutive children younger than 10 years who presented to a single, level I, pediatric emergency department and who had a distal radius fracture with or without ulna involvement between January 1, 2016, and December 31, 2017. Reductions were deemed to be potentially unnecessary if the coronal and sagittal plane angulation of the radius bone measured less than 20°and shortening measured less than 1 cm on initial injury radiographs. Use of procedural sedation or transfer status to another facility was noted if present. Statistical analysis was performed from April 2019 to June 2019. MAIN OUTCOMES AND MEASURES Potentially unnecessary reduction was the primary outcome. Radiographic findings were measured to determine reduction necessity. Additional variables measured were age, sex, time in the emergency department, transfer status, required reduction procedure, use of sedation, and cost associated with care. RESULTS Of the 258 participants studied, 156 (60%) were male, with a mean (SD) age of 6.7 (2.3) years. Among 142 patients (55%) who underwent closed reduction with procedural sedation in the emergency department, 38 (27%) procedures were determined to be potentially unnecessary. Review of Common Procedural Terminology charges revealed an approximately $7000 difference between the stated cost of a reduction procedure in the emergency department vs a cast application in an outpatient orthopedic clinic for distal radial metaphyseal fractures. The mean (SD) maximal angulation in either plane for fractures that underwent appropriate reduction was 30.6°(10.3°) compared with 13.9°(4.5°) for those unnecessarily reduced (P < .001). Patients who were transfers from other facilities were more than twice as likely to undergo a potentially unnecessary reduction (odds ratio, 2.3; 95% CI, 1.1-5.0; P = .03). CONCLUSIONS AND RELEVANCE The findings suggest that improved awareness of these acceptable deformities in young children may be associated with limiting the number of children requiring reduction with sedation, improving emergency department efficiency, and substantially reducing health care costs.

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Distal Radius Fractures

Bazzi

Shannon

Sponseller³

2015

The Pediatric Upper Extremity

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Risk Factors in Redisplacement of Distal Radial Fractures in Children

Abstract: Initial complete displacement and the degree of obliquity of the fracture line are the dominant factors affecting redisplacement. Our new radiographic index, the three-point index, should be used to predict redisplacement and assess the quality of the cast treatment of these fractures.

Cited by 134 publications

References 9 publications

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

Distal Radius Fractures

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