Selective Kirschner wiring for displaced distal radial fractures in children

This study was designed to evaluate our departmental policy of plaster immobilization and selective Kirschner (K) wiring for the management of displaced distal radius fractures in children. On a retrospective basis, we evaluated a consecutive series of 112 childhood displaced distal radius fractures (108 patients; 77 boys, 31 girls; mean age 10.5+/-2.6 years; range 5 to 16 years) presenting with clinical deformity during a two-year period. There were 97 incompletely displaced (86.6%), and 15 completely displaced (13.4%) fractures. All the fractures were managed with manipulation under general anesthesia and plaster immobilization. Additionally, K-wire fixation was performed following manipulation in seven (46.7%) of the completely displaced fractures. The mean follow-up period was 1.1 years (range 10 weeks to 2 years). The mean angulation of fractures prior to manipulation was 21.5+/-10.1 degrees, it decreased to 2.4+/-4.8 degrees following manipulation. Remanipulation was required in 11 fractures (9.8%) based on clinical and radiographic findings of redisplacement. Of these, eight fractures (8.3%) were incompletely displaced, and three fractures (20%) were completely displaced. All completely displaced fractures that required remanipulation had been additionally treated with K-wire fixation. Fractures requiring further treatment had a mean angulation of 17.1+/-5.8 degrees prior to remanipulation, and a mean residual angulation of 4.7+/-6.0 degrees at final radiographic assessment. A perfect fracture reduction was achieved in all the patients with a Salter-Harris II injury (n=22), and none of these patients required remanipulation. However, the quality of initial reduction was not associated with the development of redisplacement. There was no significant difference between isolated distal radius fractures (n=58) and combined radius and ulna fractures (n=32) with respect to remanipulation rate and final angulation (p>0.05). Final radiographs showed a significantly greater angulation in fractures which were initially completely displaced in comparison with those that were incompletely displaced (8.2+/-7.1 degrees vs. 4.2+/-5.7 degrees; p=0.024), but this was not of clinical significance. None of the patients had radial shortening and no K-wire related complications were encountered. Our data suggest that there should be other factors involved in the development of redisplacement and the need for remanipulation other than the degree of fracture displacement