Redisplacement of Paediatric Distal Radius Fractures: What is the Problem?

Constantino, Diogo M.C.; Machado, Luis; Carvalho, Marcos; Cabral, João; Cardoso, Pedro; Balacó, Inês; Ling, Tah Pu; Alves, C A F

doi:10.1302/1863-2548.15.210111

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Moreover, multifactor analysis should be considered. Factors impacting secondary displacement include age, radial translation, radioulnar fracture, fracture distance from the physis, and reduction quality [ 17 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal–diaphyseal junction fractures of the distal radius: a case-control study

Wu,

Wen,

Wang

et al. 2023

BMC Musculoskelet Disord

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Background Several methods have been used for the treatment of pediatric distal radius fractures, such as the elastic stable intramedullary nail (ESIN), Kirschner wire (K-wire), and plate, but there has been no consensus about the optimum method. The purpose of this study was to compare ESIN and K-wire techniques used in metaphyseal–diaphyseal junction (MDJ) fractures of the pediatric distal radius. Methods The data of patients who were treated at a children’s hospital affiliated with Shandong University between August 2018 and January 2022 were analyzed retrospectively. The children were divided into the ESIN and K-wire groups. Clinical outcomes were measured by the Gartland and Werley scoring system. Variables were analyzed using a statistical approach between the two groups. Results The study included 26 patients, of whom 11 were treated with K-wire and 15 with ESIN. At the final follow-up, all of the fractures were healed. There were no differences in terms of age, sex, fracture location, or wrist function score. However, the ESIN was superior to K-wire in operative time, fluoroscopic exposure, and estimated blood loss (EBL). Conclusions K-wire and ESIN are both effective methods in the treatment of MDJ fractures of the pediatric distal radius. The use of the ESIN technique represents less EBL, fluoroscopy exposure, and operation time compared with K-wire. We recommend osteosynthesis by ESIN rather than K-wires in patients with MDJ fractures of the distal radius. Level of evidence III, a case-control study.

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Section: Discussionmentioning

confidence: 99%

Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal–diaphyseal junction fractures of the distal radius: a case-control study

Wu,

Wen,

Wang

et al. 2023

BMC Musculoskelet Disord

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“…Between 2012 and 2015, 26 children aged under 17 years undergo closed manipulation and cast immobilization under general anaesthesia for a fracture for the distal third radius (Constantino et al, 2021). Redisplacement is observed in four children.…”

Section: Discussionmentioning

confidence: 99%

Distal Radius Fractures in Childhood - Our Five-Year Experience

Staykov¹,

Kolarov²

2022

IJMSR

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The most common fractures in children are those of the distal radius. There are relatively scanty publications devoted to this specific pathology in childhood. The timely diagnosis and proper treatment of the distal radius fractures are of undoubted significance. The purpose of the present communication is to share our recent practical experience with the management of the distal radius fractures in children. 2. Methodology. During the period between January 1, 2017 and December 31, 2021, 34 children at an average age of 10,85±3,00 years (between two and 17) with wrist joint injuries resulting in distal radius fractures were examined in the Clinic of Orthopedics and Traumatology, St. Anna Multiprofile Hospital of Varna. There were 21 boys at an average age of 11,43±3,39 years (between two and 17) and 13 girls at an average age of 9,92±2,38 years (between six and 12). Diagnosis was based on clinical and x-ray examinations. Therapeutic behavior included operative treatment, administration of analgesic means, immobilization, and, in some cases, subsequent rehabilitation. Surgery was accomplished under general anaesthesia in most cases. 3. Results. Mean age did not differ statistically reliably between both groups (t=1,524; p>0,05). The left radius fractures (13 in boys and 11 in girls) were statistically significantly more common than right radius ones (eight in boys and two in girls) (t=3,726; p<0,001). Most commonly, a closed reduction technique with or without internal fixation of the radius and ulna was made use of (in 15 boys and in seven girls) followed by reposition and fixation with one Kirschner wire (in one girl), with two Kirschner wires (in five boys and one girl), or with three ones (in five boys and two girls). An open reduction technique was applied in six boys and in six girls followed by reposition and fixation with one Kirschner wire (in one girl), with two Kirschner wires (in two boys and two girls), or with three ones (in two boys). It should be noted that internal fixation was not carried out in two boys and three girls. Control x-ray examination was performed in all the children. Cast immobilization for a period between 28 and 35 days, most often, for one month, was obligatorily done. Subsequently, Kirschner wires were removed in eight boys and in four girls. One complication was observed in a six-year old girl. It was caused by mechanical damage of the left wrist joint following the implantation of the internal orthopedic devices, i.e. three Kirschner wires. They were removed two months after the operation. Complete healing was achieved in all the children. 4. Conclusions. Based on these results of ours, the conclusion can be drawn that these surgical procedures along with the precise diagnosis and immobilization have proven to be safe and effective in the children with distal radius fractures. Obviously, modern strategies to successfully prevent the fractures in children should be developed.

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“…Fracture classification was made from initial presenting AP and lateral radiographs of the wrist. Fracture reduction was evaluated on postoperative radiographs and rated according to the criteria described by Constantino et al [ 12 ]: no displacement or angulation in both planes was rated ‘anatomical’; < 2 mm of displacement and < 10° of angulation was rated ‘good’; > 2 mm of displacement or > 10° of angulation was rated as ‘fair.’ In addition, both the immediate postoperative radiographs and the final healing radiographs were measured for coronal and sagittal angulation (Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…4 . We defined postoperative loss of reduction (LOR) as a change in position of one or more of the following: coronal angulation > 15°, sagittal angulation > 30° (≤ 11 years) or > 20° (> 11 years) [ 2 , 4 , 12 , 15 , 16 ]. Reduced mobility was defined as a loss of > 10° in wrist flexion/extension and/or pronation/supination compared to the contralateral side at two months postoperatively.…”

Section: Methodsmentioning

confidence: 99%

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

Bassi,

Heimann,

Schwab

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose The modified Kapandji technique has been proposed for fracture reduction in pediatric displaced distal radius fractures (DDRFs), but evidence is sparse. The purpose of this study was to evaluate our outcomes and complications, critically and systematically, when performing the modified Kapandji technique in pediatric DDRFs. Using this technique since 2011, we asked: (1) What is the quality of fracture reduction using this technique? (2) How stable is fracture alignment with this technique? (3) What are the postoperative complications and complication rates? Methods Retrospective observational study of 195 pediatric patients treated with the modified Kapandji technique. Quality of fracture reduction, fixation type (intrafocal, combined, or extrafocal), and coronal/sagittal angulation were recorded at surgery and healing. Perioperative complications were graded. Patients were stratified by fracture (metaphyseal or Salter–Harris) and fixation type, as well as age (≤ 6 years; 6 to 10 years; > 10 years). Results Fracture reduction was ‘good’ to ‘anatomical’ in 85% of patients. ‘Anatomical’ fracture reduction was less frequent in metaphyseal fractures (21% vs. 51%; p < .001). Mean angulation change was higher in metaphyseal fractures in both the sagittal (p = .011) and coronal (p = .021) planes. Metaphyseal fractures showed a higher mean change in sagittal angulation during fracture healing for the ‘intrafocal’ group. We observed a 15% overall complication rate with 1% being modified Sink Grade 3. Conclusion The modified Kapandji technique for pediatric DDRFs is a safe and effective treatment option. Metaphyseal fractures that do not involve the physis should be treated with extrafocal or combined wire fixation. Complications that require additional surgical treatment are rare. Level of evidence Level of evidence IV.

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Redisplacement of Paediatric Distal Radius Fractures: What is the Problem?

Cited by 6 publications

References 20 publications

Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal–diaphyseal junction fractures of the distal radius: a case-control study

Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal–diaphyseal junction fractures of the distal radius: a case-control study

Distal Radius Fractures in Childhood - Our Five-Year Experience

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

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