Analysis of loss of reduction as risk factor for additional secondary displacement in children with displaced distal radius fractures treated conservatively

Background: The distal radius is the most common site of fracture in childhood, and the conservativetreatment is widely used. The major casting complication is the loss of eduction and the redisplacementof the fracture.Hypothesis: According to the risk factors, close reduction and casting is the gold standard as first optionof treatment of distal radius fractures (DRFs).Methods: According to 1-week X-ray, 101 pediatric conservatively treated for DRFs patients were dividedinto 2 groups: Group A (non-displaced) and Group B (secondary displacement). The sample underwentradiographic follow-ups at the emergency room, 1, 2 and 6 weeks after-treatment. The radiographicassessment included initial translation grade, following Mani criteria; initial reduction quality; if therewere fractures of both bones; and the cast (CsI), padding (PI), canterbury (CaI), gap (GI), and three-point(3PI) indices.Results: Group A had 16 Mani grade III–IV initial translations; 37 anatomic reductions (47.4%); 48.7%fractures of both bones; and index means of CsI: 0.8, PI: 0.2, CaI: 1.0, GI: 0.16, and 3PI: 0.9. Group B had 13Mani grade III–IV initial translations; 3 anatomic reductions (13.0%); 65.2% fractures of both bone; andindex means of CsI: 0.9, PI: 0.3, CaI: 1.2, GI: 0.18, and 3PI: 1.0. The overall odds ratio indices were CsI: 4.7,CaI: 4.8, GI: 2.4, PI: 3.2, and 3PI: 3.6.Conclusion: The study hypothesis was partially confirmed: Casting is a simple, safe, effective, and inexpen-sive treatment DRFs in childhood. In our opinion, after a good-quality reduction, conservative treatmentshould be the gold standard for non-displaced and <50% of displaced fractures. CsI, PI, and CaI calculationsare recommended as secondary displacement predictors.Level of evidence: III, retrospective case control study.

a b s t r a c t Background: The distal radius is the most common site of fracture in childhood, and the conservativetreatment is widely used. The major casting complication is the loss of reduction and the redisplacementof the fracture.Hypothesis: According to the risk factors, close reduction and casting is the gold standard as first optionof treatment of distal radius fractures (DRFs).Methods: According to 1-week X-ray, 101 pediatric conservatively treated for DRFs patients were dividedinto 2 groups: Group A (non-displaced) and Group B (secondary displacement). The sample underwentradiographic follow-ups at the emergency room, 1, 2 and 6 weeks after-treatment. The radiographicassessment included initial translation grade, following Mani criteria; initial reduction quality; if therewere fractures of both bones; and the cast (CsI), padding (PI), canterbury (CaI), gap (GI), and three-point(3PI) indices.Results: Group A had 16 Mani grade III–IV initial translations; 37 anatomic reductions (47.4%); 48.7%fractures of both bones; and index means of CsI: 0.8, PI: 0.2, CaI: 1.0, GI: 0.16, and 3PI: 0.9. Group B had 13Mani grade III–IV initial translations; 3 anatomic reductions (13.0%); 65.2% fractures of both bone; andindex means of CsI: 0.9, PI: 0.3, CaI: 1.2, GI: 0.18, and 3PI: 1.0. The overall odds ratio indices were CsI: 4.7,CaI: 4.8, GI: 2.4, PI: 3.2, and 3PI: 3.6.Conclusion: The study hypothesis was partially confirmed: Casting is a simple, safe, effective, and inexpen-sive treatment DRFs in childhood. In our opinion, after a good-quality reduction, conservative treatmentshould be the gold standard for non-displaced and <50% of displaced fractures. CsI, PI, and CaI calculationsare recommended as secondary displacement predictors.Level of evidence: III, retrospective case control study.