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Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective,
Bruce S Miller1, Brett Taylor, Roger F Widmann
1Children's Hospital, Boston, Massachusetts, USA.
Insights
Percutaneous pin fixation for distal radius fractures prevents loss of reduction, unlike casting. Both methods show similar healing and complication rates, with pin issues resolving post-removal.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Distal radial metaphyseal fractures are common in children.
- Management options include cast immobilization and surgical fixation.
- Optimal treatment requires balancing efficacy, complications, and cost.
Purpose of the Study:
- To compare cast immobilization versus percutaneous pin fixation for distal radius fractures.
- To evaluate fracture healing, loss of reduction, and complications.
- To assess treatment-related costs.
Main Methods:
- Prospective randomized study of 34 patients.
- Inclusion criteria: age >10 years, >30° dorsal angulation or complete displacement.
- Comparison of cast immobilization versus percutaneous pin fixation after closed reduction.
Main Results:
- All fractures healed without deformity or functional limitations.
- 39% of casted patients experienced loss of reduction requiring remanipulation.
- No loss of reduction occurred with pin fixation; 38% had minor pin complications that resolved.
- Similar overall complication rates and treatment costs between groups.
Conclusions:
- Percutaneous pin fixation effectively prevents loss of reduction in distal radius fractures.
- Both methods yield good outcomes, but pin fixation avoids secondary displacement.
- Surgeons should consider potential short-term complications of each approach.
Abstract:
Thirty-four patients were enrolled in a prospective randomized study comparing cast immobilization alone versus percutaneous pin fixation following closed reduction of distal radial metaphyseal fractures. Patients older than 10 years of age with greater than 30 degrees of dorsal angulation or with complete fracture displacement were eligible for enrollment. Average follow-up was 10.5 weeks. All fractures healed uneventfully without deformity, growth arrest, or functional limitations. Overall complication rates were similar between groups. Thirty-nine percent of patients treated with casting had subsequent loss of reduction requiring remanipulation; there were no cases of loss of reduction in patients treated with pin fixation. Thirty-eight percent of patients treated with pin fixation had pin-related complications; all resolved following pin removal without long-term sequelae. Cost analysis showed no significant difference in treatment charges between groups. Treating surgeons should be aware of the potential short-term complications of each treatment method and adjust their postoperative care appropriately.
