Abstract
Background
The purpose of this study was to evaluate the various factors, which could contribute
towards redisplacement of distal radius fractures, including comminution of the dorsal
cortex of the distal radius, treated in our department.
Methods
In this retrospective study, we evaluated the risk of redisplacement of distal radius
fractures in our department and also looked at the probable factors predisposing to
this risk. A total of 134 fractures (129 children) were included in the study after
exclusions. The variables that were assessed as possible causes of redisplacement
were age, gender, fracture pattern (apex), degree of initial displacement, presence/absence
of comminution, presence/absence of ulnar fracture, grade of surgeon, quality of initial
reduction and Cast index.
Results
After excluding the fractures without a known outcome, 124 fractures (120 children)
were available for analysis. The average age of children was 10.6 years (range 2–16
years) with more boys (89) than girls (31). Redisplacement after an initial reduction
occurred in 30 children (24%). Six of these children (4.8% of the entire study group)
required further intervention. The factors associated with an increased risk of redisplacement
were complete initial displacement of fracture (p = 0.02), dorsal bayonet fracture pattern (p = 0.007), presence of comminution (p = 0.001) and the quality of the initial reduction (p = 0.002). Forward stepwise logistic regression analysis revealed comminution at the
fracture site to be the most significant factor associated with redisplacement, increasing
the odds of redisplacement by 5.82 (95% confidence interval (CI): 2.08–16.22, p = 0.001). There seemed to be a trend towards a reduced risk of redisplacement when K-wiring
was done in the presence of comminution (p = 0.12).
Conclusion
The presence of dorsal cortical comminution at the fracture site on initial radiographs
should alert the treating surgeon to a significantly higher risk of redisplacement
and supplemental K-wiring should be considered in this situation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Interventions for treating wrist fractures in children.Cochrane Database Syst Rev. 2009; 4: 294-377
- Risk factors in re-displacement of distal radial fractures in children.J Bone Joint Surg Am. 2008; 90: 1224-1230
- Re-displacement of paediatric forearm fractures: role of plaster moulding and padding.Injury. 2006; 37: 259-268
- Fractures in children.Lippincott Williams and Wilkins, Baltimore1955
- Above and below-the-elbow plaster casts for distal forearm fractures in children.J Bone Joint Surg Am. 2006; 88: 1-8
- Short arm plaster cast for distal pediatric forearm fractures.J Pediatr Orthop. 1994; 14: 211-213
- Percutaneous Kirschner wire pinning for severely displaced distal radial fractures in children.J Bone Joint Surg Br. 1995; 77-B: 797-801
- Distal forearm fractures in children. Complications and surgical indications.Orthop Clin North Am. 1993; 24: 333-340
- The management of isolated distal radius fractures in children.J Pediatr Orthop. 1994; 14: 207-210
- Forearm fractures in children: avoiding re-displacement.Injury. 1995; 26: 691-692
- The management of forearm fractures in children: a plea for conservatism.J Pediatr Orthop. 1999; 19: 811
- Fracture patterns in children. Analysis of 8682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population, 1950–1979.Acta Chir Scand Suppl. 1983; 202: 1-109
- Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures.Arch Orthop Trauma Surg. 2004; 124: 38-41
- Gap index: a good predictor of failure of plaster cast in distal third radius fractures.J Pediatr Orthop. 2007; 16: 48-52
- Translation of the radius as a predictor of outcome in distal radius fractures in children.J Bone Joint Surg Br. 1993; 75-B: 808-811
- Paediatric forearm and distal radius fractures: risk factors and re-displacement-role of casting indices.Int Orthop. 2009; https://doi.org/10.1007/s00264-009-0904-0
- Management of completely displaced metaphyseal fractures of the distal radius in children: a prospective, randomised controlled trial.J Bone Joint Surg Br. 2002; 84: 413-417
- Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: A prospective, randomized study.J Pediatr Orthop. 2005; 25: 490-494
- Redisplacement after manipulation of distal radial fractures in children.J Bone Joint Surg Br. 1993; 75: 453-454
- Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children.J Bone Joint Surg Am. 2006; 88: 9-17
- Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction.J Bone Joint Surg Br. 2005; 87: 841-843
Article info
Publication history
Accepted:
July 22,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
