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A prediction model for treatment decisions in distal radial physeal injuries: A multicenter retrospective study
Sudhir Kannan1,2, Han Hong Chong3, Ahmed Fadulelmola4
1Health Education England, Newcastle upon Tyne, UK.
Insights
This study identifies risk factors for deformity and complications in pediatric distal radial physeal injuries. Age over 12.5 years and dorsal angulation over 22° predict deformity, while shorter immobilization increases revision risk.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Skeletal Development
Background:
- Distal radial physeal injuries lack clear management guidelines in children.
- Identifying risk factors for deformity, physeal closure, and revision is crucial.
Purpose of the Study:
- To identify risk factors for adverse outcomes in pediatric distal radial physeal trauma.
- To develop a predictive model for deformity, physeal closure, and revision procedures.
Main Methods:
- Retrospective study of 479 patients (<16 years) with displaced distal radial physeal injuries (2011-2018).
- Defined deformity based on angulation, inclination, and ulnar variance.
- Defined physeal closure as bony bar formation across the physis.
Main Results:
- 6.6% of patients required a second procedure, 10.2% experienced physeal closure, and 6% developed deformity.
- Deformity correlated with age (p=0.04) and immobilization duration (p=0.003).
- Age >12.5 years and sagittal angulation >21.7° predicted deformity; immobilization <4.5 weeks increased revision rates.
Conclusions:
- Multivariate predictive models (nomograms) were developed with good calibration (70% sensitivity, 75% specificity).
- Recommend anatomical reduction for patients >12.5 years with >22° dorsal angulation, with immobilization ≥4.5 weeks.
- Revision procedures within 11 days of injury may reduce physeal damage risk.
Background:
There are no clearly defined guidelines for the management of distal radial physeal injuries. We aimed to identify the risk factors for patients with distal radial physeal trauma for the risk of deformity, physeal closure, and revision procedure and develop a predictive model.
Methods:
The retrospective study included patients less than 16 years old with displaced distal radial physeal injuries treated between 2011 and 2018 across five centers in the United Kingdom. Deformity was defined as a volar angulation of >11°, dorsal angulation of >15°, a radial inclination of <15° or >23°, or positive ulnar variance. Presence of a bony bar spanning the physis was considered physeal closure.
Results:
This study comprised of 479 patients. In that, 32 (6.6%) patients had a second procedure. Also, 49 (10.2%) patients had closure of physis, and 28 (6%) patients had deformity at the end of follow-up. The occurrence of deformity had a strong correlation with age (p = 0.04) and immobilization duration (p = 0.003). Receiver operating characteristic analysis showed that age >12.5 years (p = 0.006) and sagittal angulation of >21.7° (p = 0.002) had a higher odd of deformity. Immobilization for <4.5 weeks (p = 0.01) had a higher revision rate. The nomograms showed good calibration, with a sensitivity of 70% and specificity of 75%.
Interpretation:
The nomograms provide accurate, pragmatic multivariate predictive models. Anatomical reduction is recommended in patients >12.5 years of age with >22° of dorsal angulation with cast immobilization for no less than 4.5 weeks. Any revision procedure should be performed within 11 days from the date of injury to reduce the risk of physeal damage.
