Outcomes of Paediatric Distal Radius Metaphyseal Fractures

Abstract

Background: Manipulation and cast immobilisation is the accepted gold standard for management of distal radius metaphyseal fractures in children, with the use of Kirschner wires (K-wires) in cases with potential instability. The primary aim of this study was to determine the outcome of these fractures treated with our current management protocol. We also sought to identify possible risk factors for redisplacement. Methods: A retrospective study was conducted on 61 children with displaced distal radius metaphyseal fractures under the age of 16 years. Fifty-three patients were treated with manipulation and casting only, while eight patients had K-wire fixation. The primary outcome measured was redisplacement during follow-up. Initial complete displacement, an associated ulna fracture, the quality of reduction, cast and padding indices were assessed as possible risk factors for redisplacement. Results: A redisplacement rate of 18.8% was reported. We found a statistically significant association between redisplacement and non-anatomical reduction (P = 0.001), cast index (P = 0.030) and padding index (P = 0.031). Non-anatomical reduction resulted in 23.6 times more likelihood of redisplacement (P = 0.008) compared to anatomical reduction. Complete displacement and the presence of an ulna fracture had no effect on redisplacement. Conclusions: Our current treatment protocol is safe and effective based on the redisplacement rate of 18.8% which is marginally lower than current standards reported in the literature. Poor casting technique and non-anatomical reduction were found to be significant predictors of redisplacement. We suggest that K-wires be used if anatomical reduction is not achieved in older children with limited remodelling capacity.