Immediate Short-term Outcomes of Distal Radius Metaphyseal Fractures in Children

Introduction

Distal radius fractures are one of the commonest fractures in chil- dren [1]. Thirty percent (30%) to 40% of paediatric fractures occur in the forearm [2]. Fractures in the distal third of the forearm ac- count for 75% to 84% [1,2]. This is followed by diaphyseal fractures and fractures to the growth plate respectively [3]. Management of these fractures has many controversies. These range from manipu lation under anaesthesia (MUA) and casting alone versus the use of percutaneous pinning; the use of an above-elbow cast versus a forearm cast and the acceptable limits in cases of re-displacement. The aim of this project is to determine the immediate short-term outcomes of anagement in children treated for distal radius fractures. The distal radius is responsible for 80% of forearm growth and 40% overall upper extremity growth [4]. As a result, some studies report a radial and dorsal angular deformity up to 39° and 22° volar angulation with complete displacement to correct fully in children up to 10 years old [5].

Wim VAN Leemput reported an average of 7.5 months duration for remodelling in children with an open physis [6]. Major complications following distal radius fractures are rare [4], the commonly reported complication being the high rate of re-displacement (29–48%) [3,7]. McLauchlan in his randomized controlled trial (RCT) reported 21% of fractures to redisplace early after reduction [8]. Even after an anatomical reduction, loss of reduction (LOR) was observed in 24.6% [9]. A system atic review found percutaneous pinning to have a positive effect on maintaining the initial reduction and reducing fracture complica tion rate [10]. However, the decision for insertion of Kirchner-wires (k-wires) is not without controversy. Indications are unclear.