Prevention of secondary displacement and reoperation of distal metaphyseal forearm fractures in children

Eva A K van Delft; Jefrey Vermeulen; Niels W L Schep; Karlijn J van Stralen; Gerben J van der Bij

doi:10.1016/j.jcot.2020.07.016

Prevention of secondary displacement and reoperation of distal metaphyseal forearm fractures in children

J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S817-S822. doi: 10.1016/j.jcot.2020.07.016. Epub 2020 Jul 31.

Authors

Eva A K van Delft¹, Jefrey Vermeulen², Niels W L Schep², Karlijn J van Stralen³, Gerben J van der Bij⁴

Affiliations

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.

Keywords: Forearm fracture; K-wires; Metaphyseal fracture; Paediatric fracture; Radius fracture.