The fracture of the proximal end of the radius in adolescence.

According to a follow-up of 50 fractures of the proximal end of the radius in adolescence the cause and prevention of later persisting functional disturbances, posttraumatic valgisation of the elbow axis and posttraumatic growth disturbances are investigated. Furthermore, the limitations of spontaneous correction of malposition in this area during further growth should be defined. Contrary to current opinion prevailing till now in the literature, not the primary tilt, but the performed therapy turned out to be the cause for later functional disturbance: we found significantly more frequently functional restriction of pro-supination after closed or open repositions than after primary casts without any reposition. The primary malposition of the fracture has no influence on this result just as little as the remaining malposition at consolidation. Furthermore, we noted that the spontaneous correction of malposition in further growth is far more than assumed up to now: all still noticeable malpositions at consolidation up to maximum 65 degrees were corrected again spontaneously in further growth. The posttraumatic valgisation of the elbow axis showed no dependence most of all upon therapy or malposition. According to the results we recommend the following therapeutical procedure for this fracture, using to the full the correcting forces of the growing skeleton, noe performing any reposition, neither closed nor open. With that, the posttraumatic disturbance of nutrition of the proximal end of the radius should be kept to a minimum, furthermore the frequency and extent of the restriction of prosupination diminished resp. avoided. For tilts over 60 degrees as well as displacements and latus over half the width of the shaft we recommend open reposition, if possible without any fixation.