Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures

Abstract

Background and purpose Numerous follow-up visits for wrist fractures in children are performed without therapeutic consequences. We investigated the degree to which the follow-up visits reveal complications and lead to change in management. The stability of greenstick and buckle fractures of the distal radius was assessed by comparing the lateral angulation radiographically.Patients and methods The medical records of 305 distal radius fractures in patients aged less than 16 years treated at our institution in 2006 were reviewed, and any complications were noted. The fracture type was determined from the initial radiographs and the angulation on the lateral films was noted.Results Only 1 of 311 follow-ups led to an active intervention. The greenstick fractures had more complications than the buckle fractures. The lateral angulation of the buckle fractures did not change importantly throughout the treatment. The greenstick fractures displaced 5° on average, and continued to displace after the first 2 weeks. On average, the complete fractures displaced 9°.Conclusion Buckle fractures are stable and do not require follow-up. Greenstick fractures are unstable and continue to displace after 2 weeks. Complete fractures of the distal radius are uncommon in children, and highly unstable. A precise classification of fracture type at the time of diagnosis would identify a smaller subset of patients that require follow-up.

The Epidemiology of Distal Radius Fractures

“…It is important to note that children with distal radius fractures have particularly low rates of complications, 3,50 often attaining superior outcomes with casting alone. This results from the fact that the developing bone in children has a remarkable ability to remodel itself back into the correct anatomic orientation after trauma, even an injury as severe as a fracture.…”

“…A recent study showed that only 17 out of 305 distal radius fractures in children had a complication. 50 The tendency of surgeons to strive for perfect anatomic reduction in patients with distal radius fractures has caused debate over the appropriate treatment protocol for children with these injuries. A study by Do et al compared the functional outcomes of children with distal radius fractures who underwent closed reduction and those who had only splint stabilization.…”

Evaluation of Clinical Outcomes of Arm Sling versus Figure of

“…We have excluded such cases to get results more genuine and to avoid confounding factors which can affect the results. In childhood, periosteal sleeve is thicker and the bone is softer and pliable than in adults [18]. According to literature, the larger percentage of displaced clavicle fractures being encountered with increasing age [19].…”

Soft bandage versus casting in the treatment of torus fracture of distal radius in children; a prospective randomized study

“…In soft bandage group, 52 (91.22%) parents were convenient regarding the form of treatment and 5 (8.77%) were not whereas 36 (63.15 %) patients were convenient and 21(36.84%) patients were not convenient in B\E cast group. 2,[16][17][18][19][20] This study is based on the original study done by West S et al 2 who also compared the soft bandage with B\E cast for the treatment of isolated distal radius torus fracture. The results obtained by this work are nearly similar to that of original study and are statistically significant.…”