Displaced paediatric fractures of the distal radius

The purpose of this study was to review, over a fixed period of time and in a geographically defined area, all paediatric fractures of the distal radius that were initially reduced. We wished to assess the fracture pattern at different ages, the seasonal variation, the severity of the initial angulation, and the radiological outcome in terms of reangulation, remodelling, refracture, growth disturbance, and functional outcome.

A total of 88 patients were followed in a prospective setting (11 fractures of the distal radial physis). The pre- and post-reduction and follow-up radiological variables were measured. Patients with significant malangulation at union were re-examined after 7 years to assess the degree of spontaneous remodelling.

The mean malangulation before reduction was 19 degrees , after reduction 5 degrees and at union 4 degrees . Eight patients had secondary displacement during the casting period. Fractures with more than 15 degrees of malangulation at union had completely remodelled and had normal function at final follow-up.

Conservative treatment may still be regarded as the gold standard for closed paediatric fractures of the distal radius. In the present series, the remodelling capacity was excellent.