Fractures of the proximal segments of the pediatric distal radial metaphysis exhibit less angular stability than fractures of the distal segments

Abstract

The distal part of the forearm is divided into the physis, metaphysis, diaphyseal metaphyseal junction (DMJ) and diaphysis. The treatment of radial DMJ fractures is challenging because this region has diaphyseal characteristics. We speculated that the stability of metaphyseal fractures could vary depending on their proximity to the DMJ or physis. Our study aimed to investigate the stability of pediatric distal radius fractures in the physis, metaphysis and DMJ. Ninety-five patients were classified into three groups: group D, fracture line located within 1/2 of the width of the radius (WOR) from the physis; group M, fracture line located between 1/2 and 1 WOR from the physis; and group P, fracture line located between 1 and 2 WOR from the physis. We measured sagittal angulation and coronal angulation. A correction loss of less than 9° was defined as a ‘stable reduction’ outcome and one greater than 10° as a ‘loss of reduction’ outcome. The correction losses for sagittal angulation were significantly greater in groups M and P than in group D. The correction losses for coronal angulation were significantly greater in group P than in groups D and M. The incidence of ‘loss of reduction’ outcomes was significantly higher in groups M and P than in group D. The proximal segments of distal radial metaphyseal and DMJ fractures showed less angular stability than distal segments.

Stable elastic nail application with poller K-wire for Irreducible distal radius metaphyseal-diaphyseal Junction fractures in preadolescents: a new operative technique

“…As a result of the study of Tarr et al [ 19 ], they observed a 13% loss of forearm rotation in patients who recovered with more than 10 degrees of angulation. In their study, Sato et al [ 8 ] considered angulation more significant than 10 degrees after surgery as a malunion that affects clinical results. In our research, angulation of more than 10 degrees was not observed in any cases in which ESIN was applied with the poller K-wire, and the forearm rotation limitation of the patients improved below 10%.…”

“…Lieber et al defined a fracture application that remains too distal for K-wire application and too proximal for ESIN application for fractures in the DRDJM region [ 9 ]. Reduction losses were observed in the follow-ups due to insufficient K-wire fixation of fractures due to applications with very high angles to the fracture [ 8 ]. Transepiphyseal intramedullary applications have been described previously due to the difficulty of applying ESIN and the inability to obtain proper alignment [ 4 , 9 , 29 ].…”

“…In the surgical treatment of pediatric distal radius fractures, despite achieving successful outcomes with closed reduction and K-wire fixation, these techniques prove inadequate for fractures occurring at the diaphysis-metaphysis junction (DMJ). Reduction losses can be observed [ 8 ]. Due to the limited length of the distal segment in pediatric distal radius fractures, retrograde elastic stable intramedullary nailing (ESIN) application leads to displacement at the fracture site [ 8 ].…”

“…Reduction losses can be observed [ 8 ]. Due to the limited length of the distal segment in pediatric distal radius fractures, retrograde elastic stable intramedullary nailing (ESIN) application leads to displacement at the fracture site [ 8 ]. Lieber et al [ 9 ] emphasized that DRDM fractures are too proximal for fixation with a K-wire and too distal for fixation with an ESIN.…”

Modified Kapandji technique in pediatric displaced distal radius fractures: results in 195 patients

“…Evidence of fracture reduction quality, fixation stability, and complications for this technique is sparse, however. In addition, recent biomechanical studies have shown differing levels of stability in distal radius fractures involving the physis versus purely metaphyseal fractures [ 11 ].…”