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Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures

PURPOSE: Distal radius fractures (DRFs) are common pediatric injuries typically treated with closed reduction and casting. A substantial number of these fractures fail nonsurgical management, occasionally requiring surgical intervention. Risk factors associated with an unsuccessful initial closed re...

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Detalles Bibliográficos
Autores principales: LaValva, Scott M., Rogers, Benjamin H., Arkader, Alexandre, Shah, Apurva S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991732/
https://www.ncbi.nlm.nih.gov/pubmed/35415501
http://dx.doi.org/10.1016/j.jhsg.2020.05.003
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author LaValva, Scott M.
Rogers, Benjamin H.
Arkader, Alexandre
Shah, Apurva S.
author_facet LaValva, Scott M.
Rogers, Benjamin H.
Arkader, Alexandre
Shah, Apurva S.
author_sort LaValva, Scott M.
collection PubMed
description PURPOSE: Distal radius fractures (DRFs) are common pediatric injuries typically treated with closed reduction and casting. A substantial number of these fractures fail nonsurgical management, occasionally requiring surgical intervention. Risk factors associated with an unsuccessful initial closed reduction (UIR) attempt or loss of reduction (LOR) after a successful closed reduction remain poorly characterized. METHODS: This was a retrospective investigation of pediatric patients with displaced DRFs treated by closed reduction and casting at a single children’s hospital from 2013 to 2017. Patient factors (age, sex, and body mass index) and radiographic measurements (fracture type, fracture displacement, associated ulna fracture, and cast index) were evaluated to determine risk factors for UIR and LOR. RESULTS: We identified 159 children (118 boys, mean age, 11 ± 3 years) with DRFs who underwent closed reduction and casting. An initial acceptable reduction was achieved in 81% of patients, and LOR occurred in 21.7%. Higher initial fracture translation in the sagittal or coronal plane and higher initial angulation in the coronal plane were associated with higher fluoroscopy times. Higher initial translation in the sagittal plane was independently associated with UIR. After closed reduction, residual translation in the sagittal plane and cast index were independent predictors for LOR. Fractures that were completely displaced in the sagittal plane were 6.2 times less likely to undergo an acceptable initial reduction, and fractures with any residual postreduction translation in the sagittal plane were 4.7 times more likely to demonstrate LOR. CONCLUSIONS: The most important factors predicting failure of nonsurgical management of pediatric DRFs are translation in the sagittal plane and cast index greater than 0.80. To optimize patient outcomes, these variables should be recognized by the treating provider and emphasized during simulation training of orthopedic and plastic surgery residents. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
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spelling pubmed-89917322022-04-11 Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures LaValva, Scott M. Rogers, Benjamin H. Arkader, Alexandre Shah, Apurva S. J Hand Surg Glob Online Original Research PURPOSE: Distal radius fractures (DRFs) are common pediatric injuries typically treated with closed reduction and casting. A substantial number of these fractures fail nonsurgical management, occasionally requiring surgical intervention. Risk factors associated with an unsuccessful initial closed reduction (UIR) attempt or loss of reduction (LOR) after a successful closed reduction remain poorly characterized. METHODS: This was a retrospective investigation of pediatric patients with displaced DRFs treated by closed reduction and casting at a single children’s hospital from 2013 to 2017. Patient factors (age, sex, and body mass index) and radiographic measurements (fracture type, fracture displacement, associated ulna fracture, and cast index) were evaluated to determine risk factors for UIR and LOR. RESULTS: We identified 159 children (118 boys, mean age, 11 ± 3 years) with DRFs who underwent closed reduction and casting. An initial acceptable reduction was achieved in 81% of patients, and LOR occurred in 21.7%. Higher initial fracture translation in the sagittal or coronal plane and higher initial angulation in the coronal plane were associated with higher fluoroscopy times. Higher initial translation in the sagittal plane was independently associated with UIR. After closed reduction, residual translation in the sagittal plane and cast index were independent predictors for LOR. Fractures that were completely displaced in the sagittal plane were 6.2 times less likely to undergo an acceptable initial reduction, and fractures with any residual postreduction translation in the sagittal plane were 4.7 times more likely to demonstrate LOR. CONCLUSIONS: The most important factors predicting failure of nonsurgical management of pediatric DRFs are translation in the sagittal plane and cast index greater than 0.80. To optimize patient outcomes, these variables should be recognized by the treating provider and emphasized during simulation training of orthopedic and plastic surgery residents. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III. Elsevier 2020-06-09 /pmc/articles/PMC8991732/ /pubmed/35415501 http://dx.doi.org/10.1016/j.jhsg.2020.05.003 Text en © 2020 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
LaValva, Scott M.
Rogers, Benjamin H.
Arkader, Alexandre
Shah, Apurva S.
Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures
title Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures
title_full Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures
title_fullStr Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures
title_full_unstemmed Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures
title_short Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures
title_sort risk factors for failed closed reduction of pediatric distal radius fractures
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991732/
https://www.ncbi.nlm.nih.gov/pubmed/35415501
http://dx.doi.org/10.1016/j.jhsg.2020.05.003
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