Treatment of distal radius metaphyseal fractures in children: a case report and literature review

Firth, GB; Robertson, Ashley

doi:10.17159/2309-8309/2017/v16n4a10

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…Unfortunately, one case of deep infection with bone osteolysis (grade 3 according to Dahl) was diagnosed in our study population. Such deep infections after DRF CRPP are rarely reported [ 5 , 12 , 34 ]. Even though our patient responded well to the treatment, he had to undergo two separate surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…Closed, reducible fractures without neurovascular compromise are treated with either cast immobilization or manipulation under anesthesia, followed by cast immobilization [2,3]. For patients with severely displaced fractures, when reduction cannot be maintained by plaster cast or secondary displacement is expected, closed reduction followed by percutaneous pinning (CRPP) is considered a viable treatment [2,[4][5][6]. However, the evidence for management remains inconclusive, and decision-making can be challenging for a physician [2,4,6].…”

Section: Introductionmentioning

confidence: 99%

“…This wide variation stems from the different methodologies used, e.g., skin redness can be classified as an infection [19]. However, regardless of the methodology, most complications can be attributed to the presence of the Kirschner wires [4,5,7,14,20]. With an increasing trend toward surgical fixation, systematic and thorough knowledge of CRPP complication rates and their pattern might help orthopedic surgeons better counsel their patients and their parents [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

Wasiak,

Piekut,

Ratajczak

et al. 2023

Arch Orthop Trauma Surg

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Introduction Distal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures. Materials and methods One hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien–Dindo–Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites. Results Forty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery—deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common—40 wrists (33,6%). Conclusions The CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient’s postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

Wasiak,

Piekut,

Ratajczak

et al. 2023

Arch Orthop Trauma Surg

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Treatment of completely displaced distal radial fractures with a straight plaster or manipulation under anaesthesia

Marson

Craxford

et al. 2021

The Bone & Joint Journal

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Aims The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of ‘off-ended’ fractures in children with at least two years of potential growth remaining. Methods A total of 34 boys and 22 girls aged 0 to ten with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires. Results Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections. Conclusion Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy.

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Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

Vissarionov,

Bolshakov

2024

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area. AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius. MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024. RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application. CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.

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Treatment of distal radius metaphyseal fractures in children: a case report and literature review

Cited by 3 publications

References 34 publications

Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

Treatment of completely displaced distal radial fractures with a straight plaster or manipulation under anaesthesia

Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

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