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Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule

Benjamin W Iles1, Julie B Samora2,3, Satbir Singh2

  • 1Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.

Pediatric Radiology
|December 15, 2018
PubMed

Insights

A new measurement rule helps differentiate stable buckle fractures from other distal radius fractures in children aged 7 and older. This aids in tailoring treatment for pediatric distal radius fractures.

Area of Science:

  • Pediatric Orthopedics
  • Radiology
  • Pediatric Trauma

Background:

  • Distal radius fractures in children require tailored treatment based on fracture stability.
  • Differentiating stable buckle fractures from unstable fractures is crucial for appropriate management.

Purpose of the Study:

  • To develop a measurement rule for distinguishing stable buckle fractures from other distal radius fractures in children.
  • To improve diagnostic accuracy for buckle fractures in pediatric patients.

Main Methods:

  • Retrospective review of 203 pediatric distal radius fractures.
  • Measurement of fracture-to-physis distance on PA and lateral radiographs.
  • Analysis of diagnostic accuracy using ROC curves to determine cut-off values.

Main Results:

  • Buckle fractures comprised 73% of cases.
  • For children aged 7-16 years, fracture-to-physis distance <1 cm was rare (<0.9% on PA, 0% on lateral).
  • Diagnostic accuracy for buckle fractures reached 82% with specific cut-off distances, but was lower in younger children (3-6 years).

Conclusions:

  • A measurement rule using fracture-to-physis distance can enhance diagnostic accuracy for buckle fractures in children 7 years and older.
  • An isolated distal radius fracture with a fracture-to-physis distance <1 cm in children ≥7 years is unlikely to be a buckle fracture.
Abstract

Keywords:
ChildrenForearmFractureRadiographyRadiusUpper extremity

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