Determination of risk factors for instability in pediatric distal radius fractures

Abstract

Aim: Distal radius fractures (DRF) are one of the most common injuries in childhood. DRF most commonly occurs as a result of low-energy falls onto an outstretched hand, resulting in axial loading of the metaphysodiaphyseal junction of skeletally immature long bones. One of the most common complications after the closed reduction and casting of displaced DRF is fracture relocation or loss of reduction. The aim of our study is to investigate the characteristics of these fractures by retrospectively scanning the patients who require surgical intervention in patients with distal radius fractures.

Methods: Between January 2018 and January 2021, patients aged 1-16 years with a diagnosis of distal radius fracture who were treated in our hospital were included in this study. The preoperative X-rays of the patients were evaluated and the fractures were classified according to their displacement ratio. The reduction quality was rated according to the study of Alemdaroglu criteria. The distance of the fracture line to the joint line, the presence of ipsilateral ulna fracture, the angle of the fracture, and whether it was fragmented were determined. Patients with and without surgery were compared.

Results: 206 patients who met the inclusion criteria were included in the study. A significant difference was found between the non-operated and operated groups in terms of age by Student's t-test (p=0.032). The distance from the fracture line of the surgical group to the joint line was measured to be 43.8 mm on average. A significant difference was found between the non-operated and operated groups in terms of the joint line distance of the fracture line by Student's t-test (p=0.010).  There was a significant difference between the groups according to the Alemdaroğlu criteria and Mania criteria (p=0.001).

Conclusions: Our results show that complete displacement of distal radius fracture and non-anatomical reduction are important risk factors for re-displacement and therefore emerge as surgical indications in pediatric patients. Our study also emphasizes that surgical treatment may be required in older pediatric patients when the ulna fracture coexistence and the joint distance of the fracture line increases.