Analysis of loss of reduction as risk factor for additional secondary displacement in children with displaced distal radius fractures treated conservatively.

Orthop Traumatol Surg Res 2020 Feb 13;106(1):193-198. Epub 2019 Dec 13.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95124 Catania, Italy.

Background: The distal radius is the most common site of fracture in childhood, and the conservative treatment is widely used. The major casting complication is the loss of reduction and the redisplacement of the fracture.

Hypothesis: According to the risk factors, close reduction and casting is the gold standard as first option of treatment of distal radius fractures (DRFs).

Methods: According to 1-week X-ray, 101 pediatric conservatively treated for DRFs patients were divided into 2 groups: Group A (non-displaced) and Group B (secondary displacement). The sample underwent radiographic follow-ups at the emergency room, 1, 2 and 6 weeks after-treatment. The radiographic assessment included initial translation grade, following Mani criteria; initial reduction quality; if there were fractures of both bones; and the cast (CsI), padding (PI), canterbury (CaI), gap (GI), and three-point (3PI) indices.

Results: Group A had 16 Mani grade III-IV initial translations; 37 anatomic reductions (47.4%); 48.7% fractures of both bones; and index means of CsI: 0.8, PI: 0.2, CaI: 1.0, GI: 0.16, and 3PI: 0.9. Group B had 13 Mani grade III-IV initial translations; 3 anatomic reductions (13.0%); 65.2% fractures of both bone; and index means of CsI: 0.9, PI: 0.3, CaI: 1.2, GI: 0.18, and 3PI: 1.0. The overall odds ratio indices were CsI: 4.7, CaI: 4.8, GI: 2.4, PI: 3.2, and 3PI: 3.6.

Conclusion: The study hypothesis was partially confirmed: Casting is a simple, safe, effective, and inexpensive treatment DRFs in childhood. In our opinion, after a good-quality reduction, conservative treatment should be the gold standard for non-displaced and <50% of displaced fractures. CsI, PI, and CaI calculations are recommended as secondary displacement predictors.

Level Of Evidence: III, retrospective case control study.

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Source
http://dx.doi.org/10.1016/j.otsr.2019.10.013DOI Listing
February 2020

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