Re-displacement of extraphyseal distal radius fractures following initial reduction in skeletally immature patients--can it be prevented?

Abstract

PURPOSE:

The purpose of this study was to evaluate the efficacy of sugar tongs splints to maintain reduction of pediatric distal radius and distal both bones forearm fractures compared to acute casting.

MATERIALS AND METHODS:

The trauma database of an urban level-one trauma center was queried for skeletally immature patients who had sustained a displaced extraphyseal distal radius fracture. Inclusion criteria included: complete radiographs, skeletal immaturity, and presence of a displaced fracture of the radius within the metaphyseal segment, proximal to the distal radial physis, with or without an associated ulna fracture. All patients were seen in the emergency department and treated with a standardized protocol of closed reduction and immobilization. All radiographs were reviewed for initial and residual displacement. Baseline demographic data was also collected, including age at time of injury, handedness, and mechanism of injury. Need for operative intervention and associated complications were noted. All fractures were followed until union.

RESULTS:

Thirty-three patients were treated with closed reduction and immobilization in a sugar tongs splint, 10 patients were acutely casted, and 2 patients were placed into a short arm volar splint. Twenty-five patients who were initially splinted were treated to completion without the need for operative intervention. Eight of the patients treated with sugar tongs splints (24%) required surgery. Eight patients who were initially casted were treated to completion closed. Two of the patients who were initially casted (22%) required operative intervention for loss of reduction. Both of the patients who were initially immobilized using a volar splint were treated to completion without operative intervention. There was no statistically significant difference in the need for operative intervention amongst these groups.

CONCLUSIONS:

This study demonstrates that use of closed reduction and placement of a sugar tongs splint can effectively maintain reduction of extraphyseal distal radius fractures with rates of displacement similar to that seen with acute casting.

• Authors: Rachel Y Goldstein, Norman Y Otsuka, Kenneth A Egol
• Journal: Bulletin of the Hospital for Joint Disease (2013) (Bull Hosp Jt Dis (2013)) Vol. 71 Issue 2 Pg. 132-7 ( 2013) ISSN: 2328-5273 [Electronic] United States
• PMID: 24032614 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Age Factors
• Casts, Surgical
• Child
• Equipment Design
• Female
• Fracture Fixation (instrumentation)
• Fracture Healing
• Humans
• Male
• Radiography
• Radius Fractures (diagnostic imaging, surgery, therapy)
• Retrospective Studies
• Splints
• Time Factors
• Trauma Centers
• Treatment Outcome
• Ulna Fractures (diagnostic imaging, surgery, therapy)