J Korean Orthop Assoc.  2021 Jun;56(3):215-223. 10.4055/jkoa.2021.56.3.215.

Risk Factors in Stability after Immobilization of the Distal Radius in Unstable Fractures in Children

• Shin YW
• Sohn JM
• Park SY

• KMID: 2516653
• DOI: http://doi.org/10.4055/jkoa.2021.56.3.215

Abstract

Purpose
Distal radius fractures in youth are treated conservatively in most cases, but there are some cases of redisplacement in the follow-up period after cast immobilization, even after complete reduction. This study examined the risk factors of redisplacement in reduced unstable distal radius fractures.
Materials and Methods
From February 2011 to June 2018, 44 unstable distal radius fractures were managed with a closed reduction and cast immobilization. The patients were aged between 6 and 14 years. The cases of redisplacement were analyzed with the fracture characteristics (fracture obliquity, fracture level ratio, ulnar fracture combined), cast qualities (gap index, cast index, 3 point index, and radius-2nd metacarpal angle) and host factors (age, sex).
Results
The mean angulation in the union was 9.2° (0°–32.8°). In the categorical grouping 29 cases were within 10° angulation, and 15 cases were more than 10°. No significant differences in the factors of the cast indices or host factors were noted. The meaningful factor was the fracture level calculated by the relative width of the fracture site divided by the sum of width of diaphysis and epiphysis (p=0.001) and combined ulnar fracture (p=0.019).
Conclusion
Unstable distal radius fractures should be treated with more stubborn guidelines lest the fracture loses its anatomical alignment. In particular, in patients with less remodeling power, operative treatment would secure a better result if the fracture occurs in a more proximal location.

Keyword

radius fracture; closed reduction; stability