Outcomes of paediatric distal radius fractures managed with our current protocol
Date
2020
Authors
Boshomane, Tlou
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Abstract
Background: Manipulation under anaesthesia 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 for instability. Redisplacement in a cast is a common complication during follow up. The causes of redisplacement during follow up are controversial and several risk factors have been proposed as predictors of redisplacement. The primary aim of this study was to determine the outcome of our current management of paediatric distal radius metaphyseal fractures. We also sought to identify possible risk factors for redisplacement during follow up. We reported on early post-operative complications and the frequency of K-wire use. Methods: A retrospective study was conducted on 61 patients with displaced distal radius metaphyseal fractures in children under the age of 16 years who met the inclusion criteria. Fifty three patients were treated with manipulation and casting only, while eight patients had supplemental K-wire fixation. In the manipulation and casting group, the mean age was 8 ± 2.8 years (range 4 ‒ 14 years). The primary outcome was redisplacement during follow up. Initial complete displacement, an associated ulna fracture, the quality of the reduction, cast and padding indices were assessed as possible risk factors for redisplacement. Statistical analysis was done using STATA version 14.0 package. Chi-squared test was used to study the association between redisplacement and all the risk factors. Multivariate logistic regression analysis was used to assess independent risk factors. Results: A redisplacement rate of 18.8% (10 patients) was reported. We found a statistically significant association between redisplacement and non-anatomical reduction (p = 0.001), cast index > 0.8 (p = 0.030) and padding index > 0.3 (p = 0.031). Multivariate logistic regression analysis showed non-anatomical reduction to be an independent risk factor for loss of reduction with 23.6 times likelihood for redisplacement (p = 0.008) compared to anatomical reduction. Initial complete displacement and the presence of an ulna fracture had no effect on redisplacement. The frequency of K-wire use was 13.1% (eight patients) and the rate of early complications was 8.2% (five patients).Conclusions: We conclude that our current treatment is safe and effective based on the redisplacement rate of 18.8% which is comparable with current literature standards. Poor casting technique and failure to achieve 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 (> 10 years) with limited remodelling capacity to mitigate the risk of redisplacement.
Description
A research report submitted in partial fulfillment of the requirements for the degree of Master of Medicine in Orthopaedic Surgery
to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2020