Eva A K van Delft1, Jefrey Vermeulen2, Niels W L Schep2, Karlijn J van Stralen3, Gerben J van der Bij4. 1. Amsterdam UMC, Vrije Universiteit Amsterdam Department of Trauma Surgery, Amsterdam Movement Sciences, Spaarne Gasthuis, Department of Trauma Surgery Boelelaan 1117, Amsterdam, The Netherlands Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands. 2. Trauma Surgeon, Maasstad Hospital, Department of Trauma Surgery, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands. 3. Spaarne Gasthuis Academy, Spaarne Gasthuis, Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands. 4. Trauma Surgeon, Spaarne Gasthuis, Department of Trauma Surgery, Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands.
Abstract
BACKGROUND: Metaphyseal distal forearm fractures are common in paediatric patients and treating these fractures by reduction and cast immobilization alone is under debate, since secondary displacement is a frequent complication that often warrants re-intervention. This study was conducted to invest the incidence of secondary displacement and re-intervention for non-displaced and displaced fractures, with or without fixation. MATERIAL AND METHODS: A retrospective cohort study was conducted analysing all consecutive paediatric patients under the age of 16 with distal metaphyseal forearm fractures throughout a 2-year period. Data were recorded on radiographic characteristics, OTC/AO-classification, type of treatment, reduction technique, surgical interventions and removal of hardware and complications. RESULTS: 200 Patients with displaced metaphyseal forearm fractures were included of which 139 were primarily treated in the emergency room, the other 61 patients were primarily treated in the operating room. 83% Of the patients had a satisfactory reduction in the emergency room and 94% of these patients were treated successfully with casting alone. A total of 84 patients were treated in the operating room of whom 30% underwent reduction and K-wire fixation, and 70% underwent reduction and casting only. 47% Of the patients treated with closed reduction without K-wire fixation in the operating room suffered from secondary displacement, of which 80% needed re-intervention. CONCLUSION: Metaphyseal forearm fractures can be treated with a very high success rate by closed reduction and casting alone in the emergency room. Reduction and casting of displaced metaphyseal forearm fractures in children that needed treatment in the operating room however, resulted in unacceptable high rate of secondary displacement and commonly required re-intervention. Those patients should therefore be treated by reduction and K-wire fixation.
BACKGROUND: Metaphyseal distal forearm fractures are common in paediatric patients and treating these fractures by reduction and cast immobilization alone is under debate, since secondary displacement is a frequent complication that often warrants re-intervention. This study was conducted to invest the incidence of secondary displacement and re-intervention for non-displaced and displaced fractures, with or without fixation. MATERIAL AND METHODS: A retrospective cohort study was conducted analysing all consecutive paediatric patients under the age of 16 with distal metaphyseal forearm fractures throughout a 2-year period. Data were recorded on radiographic characteristics, OTC/AO-classification, type of treatment, reduction technique, surgical interventions and removal of hardware and complications. RESULTS: 200 Patients with displaced metaphyseal forearm fractures were included of which 139 were primarily treated in the emergency room, the other 61 patients were primarily treated in the operating room. 83% Of the patients had a satisfactory reduction in the emergency room and 94% of these patients were treated successfully with casting alone. A total of 84 patients were treated in the operating room of whom 30% underwent reduction and K-wire fixation, and 70% underwent reduction and casting only. 47% Of the patients treated with closed reduction without K-wire fixation in the operating room suffered from secondary displacement, of which 80% needed re-intervention. CONCLUSION: Metaphyseal forearm fractures can be treated with a very high success rate by closed reduction and casting alone in the emergency room. Reduction and casting of displaced metaphyseal forearm fractures in children that needed treatment in the operating room however, resulted in unacceptable high rate of secondary displacement and commonly required re-intervention. Those patients should therefore be treated by reduction and K-wire fixation.
Authors: Joost W Colaris; L Ulas Biter; Jan Hein Allema; Rolf M Bloem; Cees P van de Ven; Mark R de Vries; Albert J H Kerver; Max Reijman; Jan A N Verhaar Journal: Injury Date: 2012-04-06 Impact factor: 2.586
Authors: Joost W Colaris; Jan Hein Allema; L Ulas Biter; Mark R de Vries; Cees P van de Ven; Rolf M Bloem; Albert J H Kerver; Max Reijman; Jan A N Verhaar Journal: Injury Date: 2012-12-03 Impact factor: 2.586