Overall, the evidence is mounting for increasingly simplified treatment of distal radius fractures (Bae, 2012).įamiliarity with the periphyseal growth and development of the distal radius and ulna can be helpful in treating injuries in this area with early detection of growth discrepancy. The complication rates for initial management with pin fixation appear to mirror those related to any potential loss of reduction by not pinning, and no change to long-term outcome. Fractures falling outside of what is considered acceptable alignment should undergo an initial formal closed reduction. There is good evidence that minimally displaced fractures may even be treated with a simple splint similar to the buckle fractures mentioned above (Boutis, 2010). When casting fractures in this region, attentive reduction and molding allows the majority of these fractures to maintain excellent alignment in a short arm cast following the principles of the cast index (Chess, 1994). Fortunately, studies show significant remodeling potential in these injuries even with bayonet apposition and in patients age younger than 10 years, where no reduction has been attempted (Do, 2003 Crawford, 2012 Blount 1967). A debate exists as to whether these are more easily treated by completing the fracture, with benefits being greater freedom to proper align and potentially more exuberant callous formation but drawbacks being less fracture stability.įractures of the distal radial metaphysis can commonly also involve the ulna and may present with significant clinical and radiographic deformity. When at different levels, apex volar fractures are usually caused by hypersupination and are reduced in pronation, while apex dorsal fractures are caused by hyperpronation and are reduced in supination. When at the same level, a simple uniplanar reduction maneuver should suffice. ![]() When they result from a more pure bending force, the radius and ulna fracture appear at the same level. These fractures typically have a rotational component causing the fractures of the radius and ulna to appear at different levels. Greenstick fractures represent a combination of total cortical disruption and plastic deformation at the fracture site. Not only does simplified treatment perform just as well, patients seem to recover function and return to sports earlier (Plint, 2006 Bae, 2013). This can decrease health care costs and ease family burden. There is excellent evidence confirming the efficacy of simple treatment in the form of a prefabricated splint for 3 weeks, which can be removed at home at the end of treatment and obviate the need for a return visit to the clinic. Advanced imaging is rarely required, however, a CT scan may be helpful to characterize the rare pediatric intraarticular fracture of the distal radius.Ī buckle or torus fracture is inherently stable and recognized by a characteristic unicortical indent in the distal radius. In nonverbal children, sometimes the only sign of injury is decreased spontaneous movement of the extremity.ĪP and lateral radiographs of the wrist will identify subtle and displaced fractures. There is often pain with passive and active range of motion of the forearm, wrist, and hand. The physis is involved in one-third of pediatric distal radius fractures (Mann, 1990).įractures of the distal radius frequently present with pain, swelling, and tenderness localized to the wrist. ![]() Their peak incidence is 11-12 years in girls and 13-14 years in boys with the incidence being 1.5 times greater in males than females.
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