A prospective study of management of distal end of radius fracture in children
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20202689Keywords:
DER, Paediatric, Closed reductionAbstract
Background: Distal end radius (DER) fractures represents one of the common fractures in the paediatric age group. Most of this injury are managed by closed reduction and casting. We investigated the degree to which the clinical and radiographic follow-ups reveal complications that lead to a change in management of the un-manipulated distal radius fractures in children less than 14 years of age. We determined the frequency and type of complications registered during treatment, and assessed the stability of the different fracture types.
Methods: Study includes examination of 30 patients with closed DER fractures who were admitted in tertiary care centre between August 2016 to April 2018.
Results: Closed reduction and casting was modality of treatment in 40%, casting was done in 33.3% and closed reduction and k wire were done in 26.7%. In patients with closed reduction and k wire slab was given. Gartland and Werley’s scoring system was used and found that 60% patients have 0 score, 30% have 1 score, 6.7% have 2 score and 3.3% have 3 score. 29 patients had excellent result and 1 patient had fair result.
Conclusions: In this study of management of DER fracture in children with different modality of treatment, we noted that if it is an undisplaced fracture, can be managed with casting. If it is displaced fracture and reduction is achieved then closed reduction and casting can be done. If displacement is more than 50% of bone diameter then closed reduction and k wire can be done.
References
Hove LM, Brudvik C. Displaced paediatric fractures of the distal radius. Arch Orthop Trauma Surg. 2008;128:55-60.
Merchan REC. Pediatric fractures of the forearm. Clin Orthop Relat Res. 2005;432:65-72.
Alemdaroglu KB, Iltar S, Çimen O, Uysal M. Risk factors in re-displacement of distal radial fractures in children. J Bone Joint Surg. 2008;90:1224-30.
Randsborg PH, Sivertsen EA. Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures. Acta Orthop. 2009;80(5):585-9.
Friberg KS. Remodelling after distal forearm fractures in children III, Correction of residual angulation in fractures of the radius. Acta Orthop Scand. 1979;50(6-2):7419.
Mani GV, Hui PW, Cheng JC. Translation of the radius as a predictor of outcome in distal radial fractures of children. J Bone Joint Surg Br. 1993;75(5):808.
Choi KY, Chan WS, Lam TP, Cheng JC. Percutaneous Kirschner-wire pinning for severely displaced distal radial fractures in children: a report of 157 cases. J Bone Joint Surg Br. 1995;77(5):797-801.
Randsborg H, Sivertsen EA. Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures. Acta Orthop. 2009;80(5):585-9.
Proctor MT, Moore DJ, Paterson JM. Re-displacement after manipulation of distal radial fractures in children. J Bone Joint Surg Br. 1993;75(3):453-4.
Mani GV, Hui PW, Cheng JC. Translation of the radius as a predictor of outcome in distal radial fractures of children. J Bone Joint Surg Br. 1993;75(5):808.
Choi KY, Chan WS, Lam TP, Cheng JC. Percutaneous Kirschner-wire pinning for severely displaced distal radial fractures in children: a report of 157 cases. J Bone Joint Surg Br. 1995;77(5):797-801.
Strub WM, Foad SL, Mehlman CT, Crawford AH. Reduction versus remodelling in pediatric distal forearm fractures: a preliminary cost analysis. J Pediatr Orthop B. 2003;12(2):109-15.
Zimmermann R, Gschwentner M, Kralinger F, Arora R, Gabl M, Pechlaner S. Long-term results following pediatric distal forearm fractures. Arch Orthop Trauma Surg. 2004;124(3):179-86.
Zamzam MM, Khoshhal KI. Displaced fracture of the distal radius in children: factors responsible for re displacement after closed reduction. J Bone Joint Surg Br. 2005;87(6):841-3.
Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop. 2005;25(4):4904.
Hove LM, Brudvik C. Displaced paediatric fractures of the distal radius. Arch Orthop Trauma Surg. 2008;128(1):55-60.
Randsborg H, Sivertsen EA. Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures. Acta Orthop. 2009;80(5):585-9.
Leemput VW, Ridder DK. Distal metaphyseal radius fractures in children: reduction with or without pinning. Acta Orthop Belg. 2009;75(3):306.
Mazzini JP, Martin JR. Paediatric forearm and distal radius fractures: risk factors and re-displacement role of casting indices. Int Orthop. 2010;34(3):407-12.
Rijal PR, Shrestha BP, Nepal P, Khanal GP, Karn NK, Singh MP, et al. Randomized controlled trial comparing above- and below elbow plaster casts for distal forearm fractures in children. J Child Orthop. 2010;4(3):233-7.
Sharma S, Bowe D, Walters SJ, Flowers MJ. Dorsal cortical comminution as a predictor of re-displacement of distal radius fractures in children. Injury. 2011;42(2):173-7.
Mazzini JP, Beck N, Brewer J, Baldwin K, Sankar W, Flynn J. Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted. Int Orthop. 2012;36(7):1435-40.
Richards, Robin R. Chronic Disorders of the Forearm. Current Concepts Review. 1996;78(6):916-30.
Larsen WJ. Human embryology. 1 edition. 2001: 281-286.
Henry G. Osteology, forearm muscles in Gray’s Anatomy Edt. Williams, Peter L et al., Norwich, Churchill Livingstone; 1989: 410-415.
Worlock P, Stower M. Fracture patterns in Nottingham children. J Pediatr Orthop. 1986;6(6):656-60.
Bae DS, Waters PM. Pediatric distal radius fractures and triangular fibrocartilage complex injuries. Hand Clin. 2006;22(1):43-53.
Randsborg PH, Sivertsen EA. Classification of distal radius fractures in children: good inter and intra observer reliability, which improves with clinical experience. BMC Musculoskelet Disord. 2012;13:6.
Light TR, Ogden DA, Ogden JA. The anatomy of metaphyseal torus fractures. Clin Orthop Relat Res. 1984;188:103-11.
Peterson HA. Physeal fractures: Part 2. Two previously unclassified types. J Pediatr Orthop. 1994;14(4):431-8.
Peterson HA. Physeal fractures: Part 3. Classification. J Pediatr Orthop. 1994;14(4):439-48.
Peterson HA, Madhok R, Benson JT. Physeal fractures: Part 1. Epidemiology in Olmsted County M innesota 1979-1988. J Pediatr Orthop. 1994;14(4):423-30.
Evans EM. Fractures of the radius and ulna. J Bone Joint Surg Br. 1951;33(4):548-61.
Kalkwarf HJ, Laor T, Bean JA. Fracture risk in children with a forearm injury is associated with volumetric bone density and cortical area (by peripheral QCT) and areal bone density (by DXA). Osteoporos Int. 2011;22(2):607-16.
Kennedy RM, Porter FL, Miller JP. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998;102(4-1):956-63.
Ogden JA, Beall JK, Conlogue GJ. Radiology of postnatal skeletal development IV, Distal radius and ulna. Skeletal Radiol. 1981;6(4):255-66.
Pountos I, Clegg J, Siddiqui A. Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study. J Child Orthop. 2010;4(4):321-6.
Rettig ME, Raskin KB. Galeazzi fracture-dislocation: a new treatment-oriented classification. J Hand Surg Am. 2001;26(2):228-35.
Gartland JJ, Werley CW. Evaluation of healed Colles’ fracture. J Bone Joint Surg Am. 1951;33:895-907.
