Pediatric Distal Radial Fractures Treated by Emergency Physicians

Pershad, Jay; Williams, Shane; Wan, Jim Y.; Sawyer, Jeffrey R.

doi:10.1016/j.jemermed.2008.08.030

Cited by 28 publications

(21 citation statements)

References 8 publications

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“…Distal forearm injuries are among the most frequently encountered orthopaedic injuries in the paediatric emergency department [1,2]. The distal radius is the most common fracture site within forearm fractures, accounting for 20-30% of these fractures [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Mazzini

Beck

Brewer

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to identify factors which contribute to loss of reduction (LOR). Methods Outpatient records and initial, post-reduction (PR) and follow-up radiographs of patients with a distal radial metaphyseal fracture were reviewed to determine demographic factors; fracture characteristics (obliquity, comminution, intact ulna); three-point cast index (3PI); and initial, PR, and follow-up displacement (angulation and translation in the sagittal and coronal planes). Univariate and multivariate regression were used to identify significant risk factors for LOR. Results A total of 161 patients were included in our series (119 boys and 42 girls). Fifty-seven (35%) patients met the criteria for LOR. Multivariate logistic regression revealed that patients over 14 years old were 4.8 times more likely (p00.01) to lose reduction, and those with more than 10% PR translation in the sagittal plane were four times more likely (p00.03) to lose reduction. In younger patients, initial coronal translation and PR sagittal translation were independent risk factors. Patients with over 10% initial translation in the coronal plane were 2.4 times more likely (p00.01) to lose reduction, and those with over 10% PR translation in the sagittal plane were 2.7 times more likely (p00.03) to lose reduction. Three point cast index was not found to be a significant risk factor (1.64 vs. 1.57, p00.43).Conclusion Our study, the largest dedicated series of distal radial metaphyseal fractures, indicates that loss of reduction is common. Our analysis suggests that an anatomical reduction, which minimises residual translation, is the most important variable in preventing a loss of reduction.

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Section: Introductionmentioning

confidence: 99%

“…Immediate closed reduction and cast immobilisation is the mainstay of management for the majority of these fractures [2,6]. Some authors have reported good outcomes with non-operative management with few complications or long-term problems [7]; however, other authors have reported loss of reduction rates between 10% and 91%.…”

Section: Introductionmentioning

confidence: 99%

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Mazzini

Beck

Brewer

et al. 2012

International Orthopaedics (SICOT)

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“…Much of the recent literature on distal forearm fractures has focused on outcomes, comparing types of immobilization (removable splints or plaster immobilization for compression fractures) and different cast lengths for reduced fractures (below‐elbow or above‐elbow) 3 . Although focused training in fracture‐dislocation reduction techniques is part of the core curriculum of emergency medicine training programs, there are limited data assessing outcomes of pediatric forearm fractures treated with closed reduction and casting by pediatric emergency physicians (EPs) 10,11 . In an earlier report from our institution, we retrospectively reviewed outcomes of 22 patients who underwent distal forearm fracture manipulation by pediatric EPs and compared them to 42 matched controls who had reductions done by pediatric orthopedic surgeons.…”

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confidence: 99%

Closed Reduction of Distal Forearm Fractures by Pediatric Emergency Physicians

Khan

Sawyer

Pershad

2010

Academic Emergency Medicine

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Objectives: The objective of this study was to determine if there exist differences in length of stay (LOS) in the emergency department (ED) and need for reintervention to restore alignment after distal forearm fracture reduction by pediatric emergency physicians (EPs) versus postgraduate year 3 or 4 orthopedic residents.Methods: In a prospective trial at a busy urban pediatric ED, children with closed distal forearm fractures that met predefined criteria for manipulation were randomized to treatment by a postgraduate year 3 or 4 orthopedic resident or by a pediatric EP who had received focused training in forearm fracture reduction. Prereduction, postreduction, and follow-up radiographs were evaluated by an attending pediatric orthopedic surgeon who was unaware of the assigned group. The following outcomes were assessed: LOS during the initial ED encounter, adequacy of alignment immediately postreduction and at follow-up visits after discharge from the ED, the need for remanipulation, unscheduled ED visits, and radiographic healing at 6-8 weeks after injury.Results: A total of 103 children were randomized into the pediatric EP (52 patients, mean age 9.1 years) and orthopedic resident (51 patients, mean age 9.7 years) groups. Patients in the two groups were similar in age, involvement of the physes, degree of angulation, percentage of displacement, and need for procedural sedation. The mean LOS in the ED was 4.5 hours in the pediatric EP group versus 5.0 hours in the orthopedic resident group (difference in means -0.5 hours, 95% confidence interval [CI] = )1.26 to 0.37 hours). Remanipulation was required in 4 of 48 (8.3%) in the pediatric EP group versus 6 of 48 (12.5%) in the orthopedic resident group (odds ratio [OR] = 0.64; 95% CI = 0.16 to 2.67). Unscheduled ED visits for cast-related problems occurred in 6 of 51 (11.8%) in the pediatric EP group and 4 of 52 (7.7%) in the orthopedic resident group (OR = 1.59; 95% CI = 0.38 to 6.39). None of these patients with unscheduled ED visits developed compartment syndrome or required admission. 1-3 Immediate closed reduction and cast immobilization with procedural sedation is the mainstay of management for displaced or angulated fractures.4-7 Several long-term follow-up studies have shown that most such fractures are treated with closed reduction and heal without complications or long-term problems. 6,8,9 Much of the recent literature on distal forearm fractures has focused on outcomes, comparing types of immobilization (removable splints or plaster immobilization for compression fractures) and different cast lengths for reduced fractures (below-elbow or above-elbow). 3Although focused training in fracture-dislocation reduction techniques is part of the core curriculum of ª

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“…3,4 These injuries are commonmly managed by closed reduction and cast immobilisation and this is considered standard method of treatment. 2,6 Some have reported good outcomes with conservative management with few complications or long-term problems; 7 however, loss of reduction (LOR) rates between 10% and 91% have been reported by many. In general, one third of patients reported with late displacement.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The distal radius is considered as most common fracture site in the forearm fractures, accounting for 20-30%. 3,4 These fractures occur at the metaphysis 5 and their presentation vary in terms of displacement and angulation.…”

Section: Introductionmentioning

confidence: 99%

Treatment of metaphysial distal radius fractures in children by Sauve Kapandjiâ€™s intrafocal reduction method and K-wiring- A retrospective analysis

2020

IJOS

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Fractures of distal radius in metaphyseal region in paediatric age are one of most common orthopaedic injuries in the paediatric emergency department.1,2 The distal radius is considered as most common fracture site in the forearm fractures, accounting for 20-30%.3, 4 The presence of epiphysis, adjacent to the fracture, poses challenge in managing these fractures by conservative or operative means. There are concerns about the maintenance of reduction in conservative treatment, ability of the bone to completely remodel after malunion, especially fractures in children over the age of 10 years. In this study, the distal radius paediatric metaphyseal fractures, which were grossly displaced and/ or angulated were treated using Sauve Kapandji's reduction maneuver and were fixed with two parallel or cross smooth K wires. This mode of treatment gave satisfactory correction of fracture and maintainance of reduction till the union time. Grossly displaced fractures, children over 10 years, inadequately reduced fractures, the results found to be less than satisfactory. Sauve Kapandji's method of intra focal reduction gives excellent reduction, maintainance of reduction and also predictable and reproducible results in terms of function and cosmesis. Here we are retrospectively studying 20 consecutively treated patients of distal third metaphysial fractures of radius by using Sauve Kapandji's method of intrafocal reduction and fixation with K wiring at Belagavi Institute of Medical Sciences between

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Pediatric Distal Radial Fractures Treated by Emergency Physicians

Cited by 28 publications

References 8 publications

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted?

Closed Reduction of Distal Forearm Fractures by Pediatric Emergency Physicians

Treatment of metaphysial distal radius fractures in children by Sauve Kapandjiâ€™s intrafocal reduction method and K-wiring- A retrospective analysis

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