Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures

Larsen, Meredith C.; Bohm, Kyle C.; Rizkala, Amir R.; Ward, Christina M.

doi:10.1177/1558944715614861

Cited by 23 publications

(22 citation statements)

References 13 publications

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“…Additional studies have analyzed trends in physeal fractures such as age and sex predominance for specific long bones and anatomic locations [ 7 , 8 , 9 , 10 , 11 , 12 ]. Few, however, have compared all physeal fractures and identified which anatomic locations are at a higher risk for injury [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Physeal Fractures from the United States National Trauma Data Bank

et al. 2022

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Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation.

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Section: Introductionmentioning

confidence: 99%

Analysis of Physeal Fractures from the United States National Trauma Data Bank

et al. 2022

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“…Deformity may complicate DRP injuries. 1,6,12 The incidence of the distal radius deformity in this cohort was 5.8%. Nietosvaara et al 1 stated that 48% of Salter-Harris 1 and 2 distal radius fractures healed in malunion, albeit usually mild.…”

Section: Discussionmentioning

confidence: 79%

A prediction model for treatment decisions in distal radial physeal injuries: A multicenter retrospective study

Kannan

Chong

Fadulelmola

et al. 2022

Journal of Children's Orthopaedics

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Background: There are no clearly defined guidelines for the management of distal radial physeal injuries. We aimed to identify the risk factors for patients with distal radial physeal trauma for the risk of deformity, physeal closure, and revision procedure and develop a predictive model. Methods: The retrospective study included patients less than 16 years old with displaced distal radial physeal injuries treated between 2011 and 2018 across five centers in the United Kingdom. Deformity was defined as a volar angulation of >11°, dorsal angulation of >15°, a radial inclination of <15° or >23°, or positive ulnar variance. Presence of a bony bar spanning the physis was considered physeal closure. Results: This study comprised of 479 patients. In that, 32 (6.6%) patients had a second procedure. Also, 49 (10.2%) patients had closure of physis, and 28 (6%) patients had deformity at the end of follow-up. The occurrence of deformity had a strong correlation with age (p = 0.04) and immobilization duration (p = 0.003). Receiver operating characteristic analysis showed that age >12.5 years (p = 0.006) and sagittal angulation of >21.7° (p = 0.002) had a higher odd of deformity. Immobilization for <4.5 weeks (p = 0.01) had a higher revision rate. The nomograms showed good calibration, with a sensitivity of 70% and specificity of 75%. Interpretation: The nomograms provide accurate, pragmatic multivariate predictive models. Anatomical reduction is recommended in patients >12.5 years of age with >22° of dorsal angulation with cast immobilization for no less than 4.5 weeks. Any revision procedure should be performed within 11 days from the date of injury to reduce the risk of physeal damage.

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“…Remarkably, inappropriate treatment of fracture reduction and wrist valgus deformity will have a significant effect on the quality of children's life and their mental health. 13 K-wire fixation has little damage to the epiphysis because of its thin and smooth-surface needle. Among all the 30 cases in this series, 6 of the distal radius epiphyseal fractures were treated with front approach and K-wire fixation.…”

Section: Discussionmentioning

confidence: 99%

Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture

Zujie

Liu

et al. 2018

Chinese Journal of Traumatology

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PurposeTo explore the advantages of palmar approach with Kirschner-wire (K-wire) fixation in the treatment of children's distal radius extension type fracture.MethodsThirty patients, average age of 8.5 years ranging from 5 to 13 years, with distal radius extension type fracture and undergoing a failed manual reposition in our hospital were included, and treated by palmar approach with K-wire fixation between May 2014 and December 2017. Among these patients (21 male and 9 female), 5 patients had chronic injuries over 10 days, and 6 patients had fracture of the distal radius epiphysis. The time between injury and treatment ranged from 1 to 30 days. Among them, 11 patients with right-sided fractures and 19 patients with left-sided fractures were operated via the palmar longitudinal incision approach.ResultsThe results were evaluated after an average of 18 months ranging from 5 to 36 months after operation. The recovery time of fracture was from 4 to 8 weeks and all incisions were primary healing with an average of 6 weeks. Nonunion, delayed union, early closure of distal radial epiphysis, and wrist varus/valgus deformity were not found in all the cases. Based on Gartland and Wereley wrist score assessment undertaken three months after operation, excellent scores were achieved in 24 cases, good scores in 3 cases, acceptable scores in 3 cases.ConclusionThe palmar approach with K-wire fixation via a front longitudinal incision in the treatment of children's distal radius extension type fracture has following advantages: (1) easy to reposition for both fresh and old fractures; (2) less damage to surrounding tissues and epiphysis; (3) quick recovery. It is suitable to treat children's distal radius extension type fracture.

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Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures

Cited by 23 publications

References 13 publications

Analysis of Physeal Fractures from the United States National Trauma Data Bank

Analysis of Physeal Fractures from the United States National Trauma Data Bank

A prediction model for treatment decisions in distal radial physeal injuries: A multicenter retrospective study

Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture

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