Distal Radius Fractures in Children

Distal Radius Fractures in ChildrenManage most distal radius fractures in children with significant displacement by closed reduction. Generally, if a deformity is visible, reduction is appropriate.

Anesthesia

In addition to the options available for diaphyseal fractures, hematoma block is available. Its simplicity, effectiveness, and safety make it a good choice.

Manipulation

This requires considerable force. Accentuate the fracture, approximate the ends with traction, and then reposition the bones.

Acceptable Reduction

The amount depends on the child’s age. Side-to-side position is acceptable in a child. The potential for remodeling of malunions of the distal radius is great. Seldom are malunions not remodeled to an acceptable position.

Unstable Reduction

At the end of growth, unstable reduction may require internal fixation for stabilization. A single smooth K wire is usually adequate.

Immobilization

Apply a long-arm cast with the wrist flexed in the degree achieved by gravity alone. Mold the cast to produce an oval shape in cross section and provide slight pressure over the apex of the original deformity.

Complications

These include compartment syndromes, displacement in the cast (drift), and malunion.

Compartment syndromes are uncommon complications.

Displacement in the cast Drift is most likely when reduction is incomplete. Make a radiograph at about 1 week postreduction. If uncertain about the need for re-reduction, remove the cast and show the parents. If drift has caused a deformity that is unacceptable, re-reduce the fracture. If the fracture is drifting, follow closely with radiographs twice weekly. Try to identify excessive drift before union.

Malunion This often creates considerable initial concern, but over several months, the deformity remodels and seldom is it a problem beyond a year. During this period of remodeling, the family and physician may become stressed.

Buckle Fractures

These are usually stable; however, if one cortex is completely fractured, the fracture may be unstable and can drift. Repeat the radiograph at 1 week. Immobilize in a short-arm cast for about 3 weeks.

Complex Fractures

May require special management.

Distal Physeal Fractures

These fractures are usually SH-1 or SH-2 types. These fractures can usually be reduced by manipulation. SH-3 fractures require anatomic reduction. Growth arrest following these fractures may occur. Repeat an AP radiograph of the wrist in about 6 months to identify any arrest early on. Early identification allows bridge resection before significant angulation or shortening develops.

Galeazzi Fractures

The childhood equivalent of a Galeazzi fracture is distal radial and ulnar SH-2 epiphyseal fractures. Variations of this pattern can occur. This very rare fracture may be difficult to recognize. Sometimes open reduction and K wire fixation are necessary. Growth disturbance is uncommon.

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