Treatment of completely displaced distal radial fractures with a straight plaster or manipulation under anaesthesia
Ben A Marson1,2, Jimmy W G Ng1, Simon Craxford1,2
1Department of Orthopaedics, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust Queens' Medical Centre, Nottingham, UK.
Insights
Nonoperative management of pediatric distal radius fractures leads to excellent outcomes, avoiding surgical risks. This approach is a viable, potentially underutilized strategy for these common childhood injuries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Pediatric trauma
Background:
- Management of completely displaced distal radius fractures in children is controversial.
- Assessing outcomes for surgical vs. non-surgical interventions is crucial for pediatric fracture care.
Purpose of the Study:
- To evaluate outcomes of surgical and non-surgical management for displaced distal radius fractures in children with significant growth potential.
- To compare the effectiveness and complication rates of different treatment modalities.
Main Methods:
- Retrospective review of 56 children (34 boys, 22 girls) aged 0-10 years with closed, completely displaced metaphyseal distal radial fractures.
- Treatment groups included straight plaster cast (n=16) and manipulation under anesthesia with K-wire stabilization (n=40).
- Outcomes assessed via case notes and radiographs, focusing on range of motion, functional limitations, and complications.
Main Results:
- Children treated with a straight cast achieved good range of motion and functional recovery without limitations.
- Manipulation under anesthesia with K-wire stabilization resulted in re-displacement (17 children), cosmetic deformity (4), and restricted movement (9).
- Complications in the surgical group included pin site issues (11) and need for physiotherapy (4).
Conclusions:
- Nonoperative management of appropriately selected pediatric distal radius fractures yields excellent outcomes and avoids surgical risks.
- Non-surgical treatment is a safe, effective, and potentially underutilized strategy for these injuries.
- Conservative management should be strongly considered for displaced distal radius fractures in children.
Aims:
The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of 'off-ended' fractures in children with at least two years of potential growth remaining.
Methods:
A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires.
Results:
Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections.
Conclusion:
Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy. Cite this article: Bone Joint J 2021;103-B(5):902-907.
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