A systematic review of displaced paediatric distal radius fracture management: Plaster cast versus Kirschner wiring

Abstract

Displaced distal radius fractures involving the metaphysis are common childhood injuries requiring intervention. Patients frequently undergo operative treatment for these injuries. The aim of our study was to systematically review the literature comparing manipulation under anaesthesia (MUA) and Kirschner wire fixation(K wire). PRISMA guidelines were followed throughout. Medline and Cochrane databases were searched for comparative randomised controlled trials (RCTs) and cohort studies. Quality assessment was undertaken using the Jadad score, Cochrane assessment of bias tool and the Newcastle-Ottawa Scale. Data extraction was performed with customised forms. 2 RCTs and 4 cohort studies were included. There was significant variation in their methodologies, which included their inclusion criteria and threshold for remanipiulation. Re-operation rates for MUA varied from 14% to 91%. There were no recorded re-operations following K-wiring. There was a 2.2% infection rate and 4.5% rate of wire migration. There were no adverse long-term sequelae reported. All studies showed a higher re-operation rate with MUA alone. Further studies are required to identify which fracture subtypes are most susceptible to re-displacement. Current evidence suggests the use of a k-wire to stabIlise these fractures following manipulation.

Fixation of delayed distal radial fracture involving metaphyseal diaphyseal junction in adolescents: a comparative study of crossed Kirschner-wiring and non-bridging external fixator

“…Displaced distal radial fractures (DDRF) in children and adolescents usually require intervention that varies from simple manual reduction followed by well-molded casting to KW fixation and even plating [19]. In children with DDRF, the re-operation rate following manipulation under anesthesia alone ranges from 14 to 91% [20]. The limited remodeling potential and high demand for wrist function among teenagers require an acceptable reduction and adequate stabilization.…”

The Golden Ratio in Pediatric Wrist Anatomy: A Divine Symmetry

“…We believe that this observation of wrist joint anatomy could be an important factor to guide the management of distal radial fractures, as this topic remains controversial. Until now, there are no objective criteria to assess when to perform manipulation under anesthesia (MUA) or Kirschner wires (K-wires) fixation for a distal radius fracture [ 19 - 20 ]. The number φ as a guide for the normal radio-ulnar ratio could be an additional radiological tool in the arsenal of the orthopedic surgeon deciding treatment strategies for these injuries.…”

Redisplacement of Paediatric Distal Radius Fractures: What is the Problem?

“…Several studies recommend Kirschner-wire fixation over cast immobilization alone in the primary setting, even with satisfactory closed reduction. 8 , 14 A positive aspect of percutaneous pinning is its low rate of reoperation, 15 making it particularly attractive for fractures that are considered to be at a high risk for redisplacement. 1 , 14 , 16 However, it has a higher incidence of complications, namely infections, 4 , 15 and no difference in clinical outcomes has been reported between techniques.…”

“… 8 , 14 A positive aspect of percutaneous pinning is its low rate of reoperation, 15 making it particularly attractive for fractures that are considered to be at a high risk for redisplacement. 1 , 14 , 16 However, it has a higher incidence of complications, namely infections, 4 , 15 and no difference in clinical outcomes has been reported between techniques. 4 , 14 , 15 Cost of treatment is also significantly different – in our institution, total hospital cost for closed reduction and plaster casting under general anaesthesia is €176.17, while closed reduction and pinning under general anaesthesia is €1476.80.…”

“… 1 , 14 , 16 However, it has a higher incidence of complications, namely infections, 4 , 15 and no difference in clinical outcomes has been reported between techniques. 4 , 14 , 15 Cost of treatment is also significantly different – in our institution, total hospital cost for closed reduction and plaster casting under general anaesthesia is €176.17, while closed reduction and pinning under general anaesthesia is €1476.80. However, these costs are fully supported by our national healthcare system and the type of treatment performed does not affect the surgical team income.…”