Remodelling after Distal Forearm Fractures in Children III:<i>Correction of Residual Angulation in Fractures of the Radius</i>

Abstract

The outcome of residual angulation of the radius after 38 distal forearm fractures in children was investigated. The period of observation ranged from 4 months to 10 years and 8 months. The correction of a residual angulation after a fracture was shown to be governed by three factors. 1. An increase in the time between healing of the fracture and completed growth at the epiphyseal plates resulted in a more complete correction. 2. A larger adaxial dislocation of the epiphyseal plate at the time of healing of the fracture, reflecting a larger primary fracture angulation and a greater distance from the fracture to the epiphyseal plate, resulted in a less complete correction. 3. A more complete correction or overcorrection of the distal epiphyseal plate increased the correction of the angulation of the fracture. These findings strongly indicate that the process of correction of a residual angulation after a healed fracture can be explained in terms of the combined effects of the direction and amount of longitudinal growth at the epiphyseal plate. A trigonometrical equation based on this theory predicted the residual angulations of the fractures, at follow-up, with an error of less than 1 degree.