Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children?

Wendling-Keim, Danielle S.; Wieser, B.; Dietz, H.-G.

doi:10.1007/s00068-014-0483-7

Cited by 26 publications

(17 citation statements)

References 25 publications

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“…Distal radius fracture is a common injury in children and adolescents [1]. The nonoperative method of treatment remains the primary choice for the pediatric population, especially in younger children [2,3]. Adolescents with similar injury patterns of the distal radius as in adults display a unique fracture, and the vulnerable zone is usually the metaphyseal diaphyseal junction (MDJ) [4].…”

Section: Introductionmentioning

confidence: 99%

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

Rai

Tang

et al. 2020

BMC Musculoskelet Disord

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Background: Conservative treatment remains the preferred choice for distal radius fracture in children. However, loss of reduction is problematic, especially in an older child. Crossed Kirschner-wires is widely used to treat distal radius fracture in adolescents. This study aimed to compare the application of crossed Kirschner-wiring (KW) and non-bridging external fixator (EF) for the treatment of delayed distal radial fracture involving metaphyseal diaphyseal junction (MDJ) in adolescents. Methods: Between January 2012 to January 2017, 146 (male = 101, female = 45) patients in EF group and 117 (male = 76, female = 41) in KW group, were reviewed retrospectively. Preoperative data were collected from the hospital database, and postoperative clinical outcomes data were collected during the follow-up visits. We used SPSS for data analysis. Results: There existed no significant difference between EF and KW regarding sex, body weight, fracture side, duration from injury to surgery. The duration of surgery was significantly shorter in EF (30.5 ± 6.1 min) than the KW group (44.6 ± 9.4 min), P < 0.001. The number of intraoperative X-ray images was significantly lower in EF (6.5 ± 1.1) than KW (11.8 ± 2.3), P < 0.001. The incidence of tendon irritation is significantly higher in the KW (19.7%) than the EF group (0%), P < 0.001. The residual angulation on the AP view was higher in KW (3.8 ± 2.3, degrees) than the EF group (2.5 ± 1.6, degrees), P < 0.001. The volar tilting is better in EF (6.6 ± 1.1, degrees) than the KW group (1.0 ± 1.5, degrees), P < 0.001. However, the functional outcomes of the wrist showed no significant difference between EF and KW group, P = 0.086. Conclusion: The EF was superior to KW in the treatment of radial MDJ fractures in adolescents. The EF displayed shorter duration of surgery, less tendon irritation, and better radiographic outcomes than the KW. However, the cost-effect analysis remains to be investigated, because the EF is more expensive than KW.

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Section: Introductionmentioning

confidence: 99%

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

Rai

Tang

et al. 2020

BMC Musculoskelet Disord

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“…With improved understanding of biomechanics as well as clinical research, reduction of the fracture displacement has been generally accepted as the initial management to reduce local tissue pressure and release of discomforts, either in situation further open reduction and internal fixation is needed or not [ 2 ]. For pediatric population, exact and delicate manual reduction is by no means important, since closed reduction and casting of these fractures can provide definitive treatment [ 3 ]. However, painful feelings during manual reduction can not only cause discomforts and stress to the patients but also interfere with successful reduction.…”

Section: Introductionmentioning

confidence: 99%

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Tseng¹,

Leu

Chen³

et al. 2018

J Orthop Surg Res

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BackgroundProcedure sedation and analgesia (PSA) is often used to alleviate discomfort and to facilitate fracture reduction for patients with distal radius fracture in emergency departments and clinics, but risks of respiratory distress and needs for different levels of monitoring under PSA are still under concern. Hematoma block (HB) is a simple alternative method of providing rapid pain relief during reduction of distal radius fracture. However, there is still in lack of strong evidence to promote HB over PSA in clinical practice. The aim of this study was to compare HB and PSA for adult and pediatric patients during reduction of displaced distal radius fracture to identify the level of pain relief, frequency of adverse effects (AEs), and reduction failure.MethodsThe PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials.gov were searched for studies comparing HB or PSA in distal radius fracture reduction. The search revealed four randomized controlled trials and one non-randomized trial, which included two studies of pediatric subjects and three studies of adult subjects. Subgroup meta-analysis for adult and pediatric groups were specifically performed according to age difference to avoid potential bias.ResultsIn the adult group, the effect of HB on post-reduction pain severity was better than that of PSA with significant heterogeneity (Hedges’ g − 0.600, 95% confidence interval (CI) − 1.170 to − 0.029, p = 0.039), although there was no difference on the pain severity during reduction between these two groups with significant heterogeneity (Hedges’ g 0.356, 95% CI − 1.101 to 1.812, p = 0.632). In the pediatric group, the treatment effect on pain severity was significantly better by HB than that by PSA but without significant heterogeneity (Hedges’ g − 0.402, 95% CI − 0.718 to − 0.085, p = 0.013, I2 < 0.001%). Most of the reported adverse effects (AEs) include nausea, vomiting, and respiratory distress developed in adult patients treated by PSA. The rates of reported AEs did not significantly differ between HB and PSA in the pediatric group. Additionally, final outcomes of reduction failure did not significantly differ between HB and PSA in both adult and pediatric groups.ConclusionHematoma block is a safe and effective alternative of anesthesia in reduction of distal radius fracture without inferior pain relief compared with PSA among adult and pediatric patients.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0772-7) contains supplementary material, which is available to authorized users.

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“…This was a Level III comparative cohort study of 39 patients. 33 This was supported by Wendling-Kim et al 34 Selective K-wire insertion was confirmed by Jordan et al who advocated the use of K-wires for patients in whom suboptimal initial reduction was obtained. Optimal reduction was defined as less than 10% translation or less than five degrees of angulation.…”

Section: Manipulation Alone Vs Use Of K-wiresmentioning

confidence: 89%

Treatment of distal radius metaphyseal fractures in children: a case report and literature review

Firth

Robertson

2017

SA orthop. j.

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Background: The management of displaced distal metaphyseal radius fractures in children is controversial-specifically the prevention of redisplacement. The aim of this article is to establish the indications for the use of Kirschner wires (K-wires) in the management of distal radius fractures in children by reviewing the current literature. The objectives were to establish the remodelling potential in children, factors associated with redisplacement, indications for using K-wires and potential complications of K-wires in distal radius fractures. Methods and results: A 7-year-old boy with a displaced distal radius fracture was taken to theatre for manipulation and percutaneous fixation with K-wires and subsequently developed a chronic osteomyelitis secondary to the K-wire insertion. Conclusion: Children under 10 years of age have excellent remodelling potential. The most important risk factors for redisplacement are complete initial displacement, non-anatomic reduction and poor plaster technique. In light of a complication rate of up to 17%, selective use of K-wire fixation in uncomplicated closed fractures should only be considered in children over the age of 10 years in fractures with complete displacement where anatomical reduction cannot be achieved.

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Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children?

Cited by 26 publications

References 25 publications

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

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

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Treatment of distal radius metaphyseal fractures in children: a case report and literature review

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