Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children?

Abstract

Purpose: The therapy of distal radial fractures in children is expected to be as non-invasive as possible but also needs to deliver the definite care for gaining optimal reduction and stabilizing the fracture. Therefore, closed reduction and immobilization is competing with routine Kirschner wire fixation. The aim of our study was to investigate if closed reduction and immobilization without osteosynthesis can ensure stabilization of the fracture.

Methods: We chose a retrospective study design and analyzed 393 displaced distal radial fractures in children from 1 to 18 years with open epiphyseal plates studying medical files and X-rays. The Pearson's χ (2) test was applied. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an alpha level of P = 0.05.

Results: Of these studied fractures 263 cases were treated with closed reduction and immobilization. Only 38 of these needed secondary interventions, 28 of these underwent reduction after redisplacement and ten patients received secondary Kirschner wire fixation. The last follow-up examination after 4-6 weeks revealed that 96.4% of fractures initially treated with closed reduction and immobilization were measured within the limits of remodeling. 104 of the studied fractures were treated with cast immobilization alone when displacement was expected to correct due to remodeling. Here 22.1% of patients needed secondary reduction. Furthermore, primary Kirschner wire fixation was performed in only 25 children with unstable fractures and only one received further treatment. Interestingly, operative reports of primary closed reduction revealed that repeated maneuvers of reduction as well as residual displacement are risk factors for redisplacement.

Conclusion: For the treatment of displaced distal radial fractures in children closed reduction and immobilization can be considered the method of choice. However, for cases with repeated reduction maneuvers or residual displacement we recommend primary Kirschner wire fixation to avoid redisplacement.

Level of evidence: Retrospective comparative study, Level III.

Figures

Fig. 1

The age distribution demonstrates the majority of patients in the study were between 6 and 11 years of age

Fig. 2

It shows that most patients studied were treated with closed reduction and cast immobilization

Fig. 3

Primary closed reduction and immobilization was applied for all age groups, however, the majority of patients was aged 6–11 years

Fig. 4

The age distribution of patients needing secondary intervention after primary reduction demonstrates the dependence of frequency and type of secondary treatment on the remodeling potential according to the patient’s age

Fig. 5

Factors influencing redisplacement are shown here for patients primarily treated with closed reduction and immobilization

Fig. 6

The age pattern of patients primarily treated with immobilization is depicted here

Fig. 7

Secondary intervention after primary cast immobilization alone consisted of secondary reduction only. Due to their remodeling potential, most patients were between 6 and 11 years of age

Fig. 8

More than half of patients treated with Kirschner wire fixation were older than 11 years of age