Distal Radius Salter–Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children

Abstract

Objectives: To assess factors affecting the loss of reduction (LOR) in a large cohort of children with Salter–Harris Type II (SH II) distal radius physeal fractures treated with closed reduction. Design: Retrospective chart review. Setting: Pediatric Level I Trauma Center. Patients/Participants: A total of 141 pediatric patients (73% male, average age: 12.15 ± 2.55 years) that had undergone closed reduction and casting for distal radius physeal fractures from 2006 to 2019 were included in this study. Intervention: Closed reduction and casting. Main Outcome Measurements: Five different radiographic measurements were analyzed at 4 different time points. Follow-up radiographs were assessed in relation to initial reduction. LOR was defined as >5 degrees change of angulation on PA radiographs, >10 degrees change of angulation on lateral radiographs, and/or >25% translation on PA or lateral radiographs. Results: LOR was seen in 28.4% of the patients, most often (68%) in the first 2 weeks after initial reduction. Seven (17.5%) of these patients (average age: 15.2 ± 2.0 years) were treated surgically with closed reduction and percutaneous pinning (CRPP). Patients undergoing CRPP for LOR were an average of 3.4 years older (P < 0.001) than those who underwent nonoperative treatment of LOR. Patients with initial angulation more than 5 degrees on the PA view to be twice as likely to have LOR (P = 0.03). Conclusions: LOR was seen in nearly 1/3 of these patients. Patients with initial higher degree of angulation on the coronal plane are at higher risk for LOR. Age, not the degree of angulation, is the main predictor for potential surgical treatment. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

What’s New in Pediatric Orthopaedics

“…In a study of 141 Salter-Harris II distal radial fractures treated with closed reduction, 40 (28.4%) had a loss of reduction, and 7 of those required a subsequent surgical procedure 5 . The risk factors were primarily older age and initial angulation of >5° on the coronal radiograph.…”