Distal radius fractures in children aged 5–12 years: a Swedish nationwide register-based study of 25 777 patients

Abstract

Background Distal radius fracture (DRF) is the most common type of fracture in children. There is no clear consensus on primary treatment for complete DRFs. Kirschner wire (K-wire) fixation has been recommended, to avoid the risk of redislocation. However, recent studies have indicated that casting can be sufficient, at least for children with two or more years left to grow. There is no recent study regarding pediatric DRFs and the extent of K-wire fixations in the Swedish population. The purpose of this study was to investigate epidemiology and treatment of pediatric DRFs registered in the Swedish Fracture Register (SFR). Methods In this retrospective study, based on data from SFR for children aged 5–12 years with DRF between January 2015 and October 2022, we investigated epidemiology and choice of treatment. Sex, age, type of DRF, treatment, cause and mechanism of injury, were analyzed. Results In total, 25,777 patients were included, 7,173 (27%) with complete fractures. Number and peak age of girls vs. boys with fractures were 11,742 (46%), 10 years, and 14,035 (54%), 12 years, respectively. Odds ratio (OR) for a K-wire fixation in girls vs. boys was 0.81 (95% confidence interval (CI) 0.74–0.89, p < .001). With age 5 -7 years as reference, OR for age group 8–10 years was 0.88 (95% CI 0.80–0.98 p = .019) and OR for age group 11–12 years was 0.81 (95% CI 0.73–0.91 p = < .001. Conclusion Casting only was the preferred treatment for all fractures (76%). Boys acquired DRFs more often than girls, with a peak age of 12 years. Younger children and boys with a complete fracture were more likely than older children and girls to receive a K-wire. Further research regarding indications for K-wiring of DRFs in the pediatric population is needed.

A qualitative study of clinicians’ experience of a clinical trial for displaced distal radius fractures

“…2 Non-surgical casting with approximate alignment is a standard treatment in other parts of the world. 3 Nevertheless, clinicians have been concerned about outcomes of non-surgical casting as there is little high-quality evidence to support this practice, coupled with a degree of apprehension about not correcting the appearance of a fracture with obvious initial deformity.…”

Cost-effectiveness analysis of soft bandage and immediate discharge versus rigid immobilization in children with distal radius torus fractures

“…They result from trauma to growing bones and account for two-thirds of all wrist fractures in children, which equates to approximately 60,000 UK emergency department (ED) attendances annually. 1-4 There is widespread agreement that these fractures universally heal well. There has been a longstanding doctrine of rigid immobilization in cast for wrist fractures, 5 tempered by newer evidence to suggest that simpler treatment methods (e.g.…”

Intramedullary Kirschner wire fixation of displaced distal forearm fractures in children

“…Fractures of the distal radius and forearm are among the most common injuries in children, boys are more affected than girls especially the older age group around 12 years, while younger age groups with complete fractures may require surgical treatment more often [ 1 ]. Radius fractures account for 20% of all childhood fractures, and 62% of them are radial metaphyseal fractures [ 2 ].…”