Loss of Reduction in Pediatric Distal Radius Fractures: Risk Factors From a Prospective Multicenter Registry.

Area of Science:

• Orthopedics
• Pediatric Surgery
• Traumatology

Background:

• Management of unstable pediatric distal radius fractures remains uncertain despite existing studies.
• Single-center data limits generalizability for treatment strategies.

Purpose of the Study:

• To identify patient factors and fracture characteristics predicting loss of reduction (LOR) or need for secondary procedures after closed reduction.
• To analyze outcomes in a large, prospective multicenter cohort of pediatric distal radius fractures.

Main Methods:

• Prospective enrollment of 616 children (aged 4-18) with displaced distal radius fractures from the Pediatric Distal Radius Fracture (PDRF) Registry.
• Radiographic LOR defined as ≥10° angulation change or ≥2 categories of translation.
• Bivariate and multivariate logistic regression analyses performed to identify risk factors.

Main Results:

• Radiographic LOR occurred in 44% of fractures; 11% shifted ≥20°.
• Independent predictors for LOR included bicortical metaphyseal pattern (OR=2.3), prereduction translation ≥51% (OR=2.3), and nonanatomic reductions (OR=1.9).
• 8% of children required secondary procedures; patient age, sex, and BMI were not significant predictors.

Conclusions:

• Redisplacement is common (44%) after closed reduction of pediatric distal radius fractures, driven by fracture characteristics.
• Bicortical pattern, significant prereduction translation, and nonanatomic reduction are key risk factors for LOR.
• Minimizing residual translation during primary closed reduction is crucial to prevent angulation-driven LOR and subsequent complications.