CORR Insights®: Do We Need to Stabilize All Reduced Metaphyseal Both-bone Forearm Fractures in Children with K-wires?

Abstract

Where Are We Now? "D octor, does my child really need to go under anesthesia and have wires drilled into his bone?""Will fixing his wrist with wires make his arm perfect?" "We do not have a very good health insurance; how much is it going to cost to do surgery on him versus just putting him into a cast?"

The Slipper Fracture: Revisited

“…In fact, because of the high risk that distal forearm fractures at the junction of the metaphysis and diaphysis will angulate in a cast, some authors recommend more aggressive initial surgical treatment with closed reduction, K-wire fixation, and casting [ 8 , 9 ]. One study demonstrated that when comparing distal radius and distal radius and ulna fractures treated with a long arm cast compared to a K-wire and a long arm cast, those treated without a K-wire sustained more displacements in the cast.…”

“…One study demonstrated that when comparing distal radius and distal radius and ulna fractures treated with a long arm cast compared to a K-wire and a long arm cast, those treated without a K-wire sustained more displacements in the cast. However, at a five-year follow-up, there were no differences between the two groups, and all fractures were eventually remodeled [ 8 ]. Pollen [ 2 ] also reported that young patients with open growth plates are able to correct the angulation deformity over time with fracture remodeling.…”