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...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-07-01
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| Series: | Journal of Hand Surgery Global Online |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589514120300475 |
| _version_ | 1811261601883357184 |
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| author | Scott M. LaValva, BA Benjamin H. Rogers, BA Alexandre Arkader, MD Apurva S. Shah, MD, MBA |
| author_facet | Scott M. LaValva, BA Benjamin H. Rogers, BA Alexandre Arkader, MD Apurva S. Shah, MD, MBA |
| author_sort | Scott M. LaValva, BA |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-12T19:07:29Z |
| format | Article |
| id | doaj.art-16492e53fdb14b9695e53a9a5db19d31 |
| institution | Directory Open Access Journal |
| issn | 2589-5141 |
| language | English |
| last_indexed | 2024-04-12T19:07:29Z |
| publishDate | 2020-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj.art-16492e53fdb14b9695e53a9a5db19d312022-12-22T03:19:59ZengElsevierJournal of Hand Surgery Global Online2589-51412020-07-0124196202Risk Factors for Failed Closed Reduction of Pediatric Distal Radius FracturesScott M. LaValva, BA0Benjamin H. Rogers, BA1Alexandre Arkader, MD2Apurva S. Shah, MD, MBA3Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PADivision of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PADivision of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PADivision of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Corresponding author: Apurva S. Shah, MD, MBA, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104.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.http://www.sciencedirect.com/science/article/pii/S2589514120300475Cast indexClosed reductionLoss of reductionPediatric distal radius fracture |
| spellingShingle | Scott M. LaValva, BA Benjamin H. Rogers, BA Alexandre Arkader, MD Apurva S. Shah, MD, MBA Risk Factors for Failed Closed Reduction of Pediatric Distal Radius Fractures Journal of Hand Surgery Global Online Cast index Closed reduction Loss of reduction Pediatric distal radius fracture |
| 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 | Cast index Closed reduction Loss of reduction Pediatric distal radius fracture |
| url | http://www.sciencedirect.com/science/article/pii/S2589514120300475 |
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