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[Prognosis of proximal radius fractures in the growth period]
1Traumatologische Abteilung, Kinderspital, Basel.
Insights
Displaced proximal radius fractures in children often heal well with conservative treatment. Most children experience good function and spontaneous correction of angulation, avoiding surgical complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Pediatric Orthopedics
Background:
- Proximal radius fractures in children can cause radial head deformities and affect forearm rotation.
- Trauma can be exacerbated by surgical intervention and aggressive rehabilitation.
Purpose of the Study:
- To evaluate the long-term functional outcomes and radiographic results of displaced proximal radius fractures in children.
- To compare conservative versus surgical management outcomes for pediatric proximal radius fractures.
Main Methods:
- Prospective long-term follow-up study of 38 children with displaced proximal radius fractures.
- Assessment of functional outcomes and radiographic changes over 2-20 years post-trauma.
Main Results:
- Only 11% of children experienced functional disturbances.
- Radial head deformities were present in 83% of radiographs but did not correlate with functional impairment.
- Conservative treatment showed spontaneous correction of angulations up to 60 degrees.
- Functional impairment was primarily associated with open reduction or secondary growth disturbances.
Conclusions:
- Conservative management is recommended for pediatric proximal radius fractures due to high complication rates and poor functional results associated with open reduction.
- Primary non-operative treatment offers favorable outcomes, minimizing risks and improving patient convenience and economic aspects.
Abstract:
Fractures of the proximal radius in children may lead to deformities of the radial head and functional disturbance of pro- and supination. However, traumatization is not only caused by the injury itself, but may also occur secondary to surgical reduction, manipulation of fracture fragments and excessive physiotherapy. In a prospective long-term follow-study (2-20 years after trauma) of 38 children with displaced proximal radius fractures we found functional disturbances in 11% of children only. These were not caused by radial head deformities, which were present on 83% of follow-up radiographs. Functional impairment was mainly seen after open reduction or secondary growth disturbances. On follow-up radiographs all conservatively treated fracture angulations up to 60 degrees had corrected themselves spontaneously. In view of the high complication rates after open reduction and the poor functional results, as well as the inconvenience for the pediatric patient and the economic aspects, we recommend a primary conservative treatment concept of proximal radius fractures in children.