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Surgical Outcomes of Displaced Metaphyseal Distal Radius Fractures in Children: A Consecutive Case Series of 100
Qamar Mustafa1, Barry Mullins2, Harold Akehurst3
1Trauma and Orthopaedics, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, GBR.
Background:
Distal radius fractures are among the most common type of fracture seen in the paediatric population. Manipulation under anaesthesia (MUA), with or without Kirschner wire (K-wire) fixation, is the standard treatment for metaphyseal fractures. This study assessed outcomes by fracture type and operative modality.
Methods:
One hundred consecutively surgically treated metaphyseal distal radius fractures in children aged 4-10 years were retrospectively reviewed in our centre. Treatments included MUA with cast alone (MUA/cast) or MUA with K-wire fixation (MUA/K-wire). Fracture type, complications, return to theatre, and time to union/discharge were analysed. Results: Of 100 patients (46 female, 54 male; mean age 7.4 years), 59 had angulated fractures and 41 had off-ended fractures. 44 (75%) angulated fractures were treated with MUA/cast, while 33 (80%) off-ended fractures were managed with MUA/K-wire. Seven (7%) patients required further surgery for redisplacement. In the off-ended group, redisplacement occurred in two of eight (25%) MUA/cast cases compared with 2 of 33 (6%) MUA/K-wire cases (p=0.16). Overall, K-wire augmentation showed a trend towards reduced risk of re-operation (p=0.059). All fractures united (mean 44.5 days); however, off-ended fractures took significantly longer to heal (p=0.04). Among 48 MUA/K-wire cases, 15 (31%) developed complications, including wire migration, irritation, granulation tissue, hypertrophic scarring, and return for wire removal. Seven malunions remodelled spontaneously, including one from 25° dorsal displacement to normal alignment.
Conclusion:
Off-ended fractures treated with MUA/cast were more likely to redisplace than those treated with MUA/K-wire, though K-wire fixation carried higher complication rates. Given the excellent remodelling potential in children aged 4-10 years, MUA/cast is recommended where stability can be achieved, as it reduces complications while still allowing reliable remodelling.
