Selective Kirschner wiring for displaced distal radial fractures in children

Luscombe, Karen L; Chaudhry, Samena; Dwyer, Jonathan; Shanmugam, Chezhiyan; Maffulli, Nicola

doi:10.3944/aott.2010.2133

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…Many studies have been performed to identify risk factors for redisplacement showing varying results. Several studies recommended additional K-wire fixation for not optimally reduced distal radius fractures, while others recommended additional K-wire fixation for all completely displaced fractures, even after an acceptable closed reduction [ 7 , 9 , 15 , 16 ]. More recently, the quality of cast moulding was evaluated as a potential risk factor for redisplacement, however, without univocal results [ 5 , 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Sengab

Krijnen

Schipper

2019

Eur J Trauma Emerg Surg

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Purpose Displaced distal radius fractures in children are common and often reduced if necessary and immobilized in cast. Still, fracture redisplacement frequently occurs. This can be prevented by fixation of fracture fragments with K-wires, but until now, there are no clear guidelines for treatment with primary K-wire fixation. This meta-analysis aimed to identify risk factors for redisplacement after reduction and cast immobilization of displaced distal radius fractures in children, and thereby determine which children will benefit most of primary additional K-wire fixation. Methods Eight databases were searched to identify studies and extract data on the incidence of and risk factors for redisplacement of distal radius fractures after initial reduction and cast immobilization in children. Results Twelve studies, including 1256 patients, showed that initial complete displacement (odds ratio [OR] 4.69, 95% confidence interval [CI] 2.98-7.39) and presence of a both-bone fracture (OR 1.95, 95% CI 1.34-2.85) were independent risk factors for redisplacement. Anatomical reduction reduced the redisplacement risk (OR 0.14, 95% CI 0.05-0.40). No significant influence on redisplacement risk could be established for female sex, experience level of the attending surgeon, Cast Index < 0.8, Three-Point Index < 0.8 and patient's age. Conclusions For children with a displaced distal radius fracture, the presence of a both-bone fracture, complete displacement of the distal radius and non-anatomical reduction are risk factors for redisplacement after reduction of their initially displaced distal radius fracture. Children with one or more of these risk factors probably benefit most of reduction combined with primary K-wire fixation.

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Section: Introductionmentioning

confidence: 99%

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Sengab

Krijnen

Schipper

2019

Eur J Trauma Emerg Surg

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“…[ 22 , 23 ] Therefore, a number of surgeons recommend pinning to augment the reduction to prevent re-displacement. [ 24 , 25 ] In all 6 papers, our review found significantly higher re-displacement rates in the casting therapy group. [ 13 , 17 – 21 ] Overall, the mean re-displacement rate found in this systematic review was 40.0% in the casting group compared with 3.6% in the pinning group (Chi-square tests, P < .001).…”

Section: Discussionmentioning

confidence: 89%

Is percutaneous pinning needed for the treatment of displaced distal radius metaphyseal fractures in children?

Zeng

Sun

et al. 2018

Medicine

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Background:Distal radius metaphyseal (DRM) fractures are very frequent childhood fractures. Whether additional percutaneous pinning improves the outcome remains controversial. In this review, we tried to systematically evaluate the effect of percutaneous pinning on re-displacement, secondary reduction, radiographs, function, and complications in children with displaced DRM fractures.Methods:PubMed, Medline, Embase, Cochrane Library, and Web of Science databases were explored systematically to identify randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing cast immobilization alone or following reduction to additional percutaneous pinning in the treatment of pediatric displaced DRM fractures. Two reviewers independently screened eligible articles and extracted relevant information from each article. The methodological quality of eligible articles was evaluated using the Cochrane Collaboration risk assessment tool (RCTs) and modified Jadad scale (CCTs).Results:A total of 4 RCTs and 3 CCTs met the inclusion criteria, with a total patient count of 1144 children. The results showed that additional percutaneous pinning significantly reduced the rate of re-placement (Chi-square tests, P < .001) and complications (Chi-square tests, P = .030). The superior results, both radiographically and functionally seemed to be temporary. No difference was found between the 2 groups after longer-term follow-up.Conclusions:This systematic review suggested that compared with casting following reduction, percutaneous pinning had a positive effect on maintaining the initial reduction and reducing fracture complication rate of displaced DRM fractures in children, but with no significant improvement in function and radiographic outcome at the long-term follow-up. We suggest clinicians think twice before percutaneous pinning of displaced pediatric DRM fractures.

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“…Um eine sekundäre Dislokation sicher vermeiden zu können, wird von vielen Autoren eine primäre Reposition mit perkutaner K-Draht-Osteosynthese gefordert [11,12,18]. Obwohl diese die sekundäre Dislokation weitgehend verhindert, gibt es keine belastbaren Daten zu den Langzeitergebnissen, die in einem Cochrane-Review dringend gefordert werden [1,13].…”

Section: Grünholzfrakturen Und Komplette Frakturen Mit Angulationunclassified

Konservative oder operative Therapie der distalen metaphysären Unterarmfraktur

Adrian

Wessel

2015

Trauma Berufskrankh

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Metaphysäre distale Unterarmfrakturen sind die häufigsten Frakturen imKindes-und Jugendalter und machen 20-25% aller Frakturen in diesem Alter aus. Wulstfrakturen und komplette Frakturen mit Dislokation bieten klare Behandlungsvorgaben. Unklar ist hingegen die Behandlung der angulierten Grünholzfrakturen. Trotz Reposition kommt es in gut 30% der Fälle zur erneuten Dislokation.Abb. 1 9 Wulstfraktur. a Anterior-posteriore Aufnahme, b seitliche Aufnahme Übersichten SchlüsselwörterKnochenfrakturen · Rekorrektur · Konservative Therapie · Kinder · Frakturfixation Conservative or operative therapy of distal metaphyseal forearm fracture. Where is the boundary? Abstract Background. Incomplete greenstick fractures and complete fractures without shortening occurring at the distal metaphysis of the forearm are very frequent fractures in childhood. The treatment of these fractures is a matter of controversial discussion. Despite manipulation and/or pinning the risk of redisplacement is approximately 30 %. Objective. Is repositioning with K-wire osteosynthesis or other synthesis procedures necessary for these fractures or can the spontaneous remodeling capacity be used for treatment and make an operation superfluous? Methods. Analysis of existing studies on this topic. Results.There are no clear guidelines and not enough studies that take the remodeling potential into consideration. Conclusion.A study similar to the angulated fractures of the distal forearm in children (AFIC) study is needed that compares a purely conservative treatment with repositioning and fixation via K-wires in a controlled, randomized and prospective study.

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Selective Kirschner wiring for displaced distal radial fractures in children

Cited by 17 publications

References 23 publications

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Is percutaneous pinning needed for the treatment of displaced distal radius metaphyseal fractures in children?

Konservative oder operative Therapie der distalen metaphysären Unterarmfraktur

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