The Management of Isolated Distal Radius Fractures in Children

TLDR

In a consecutive series of 175 forearm fractures in children, 23 isolated distal radius fractures required manipulation for unacceptable angulation or displacement. The 23 patients were randomized to either manipulation with cast alone or manipulation with percutaneous Kirschner wire fixation plus cast, and were followed clinically and radiographically until union. Percutaneous wiring resulted in no complications and all satisfactory outcomes, whereas cast alone led to a 91 % failure rate requiring further manipulation, supporting wiring as the preferred treatment for these fractures.

Abstract

Summary: In a consecutive series of 175 forearm fractures requiring manipulation in children who presented to the John Radcliffe Hospital between 1 January 1991 and 30 June 1992, 23 had isolated distal radius fractures, all of which required manipulation for unacceptable angulation or displacement. We had previously noted that these fractures had a high incidence of loss of position leading to malunion. The 23 patients were randomly allocated to one of two treatment groups: either manipulation and cast alone, or manipulation and percutaneous Kirschner wiring with cast. These two groups were followed up clinically and radiographically until union occurred. Those fractures treated by percutaneous wiring had no significant complications, and all had a satisfactory result. The fractures treated by manipulation and casting alone required further manipulation in 10 cases (91%). We conclude that these problematic fractures should be treated by stabilisation with percutaneous wiring.