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Minimally angulated pediatric wrist fractures: Is immobilization without manipulation enough?

Published online by Cambridge University Press:  21 May 2015

Khalid Al-Ansari
Affiliation:
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ont.
Andrew Howard
Affiliation:
Division of Orthopedic Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ont.
Brian Seeto
Affiliation:
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ont.
Solina Yoo
Affiliation:
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ont.
Salma Zaki
Affiliation:
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ont.
Kathy Boutis*
Affiliation:
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ont.
*
Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8

Abstract

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Background:

Emergency department (ED) manipulation of complete minimally angulated distal radius fractures in children may not be necessary, due to the excellent remodeling potential of these fractures.

Objectives:

The primary objective of this study was to determine the proportion of minimally angulated distal radius fractures managed in the ED with plaster immobilization that subsequently required manipulation. Our secondary objective was to document, at follow-up, changes in angulation for each wrist fracture.

Methods:

This retrospective cohort study reviewed consecutive records of all children with bi-cortical minimally angulated (≤15° of angulation in the sagittal plane and ≤0.5 cm of displacement) distal metaphyseal radius fractures, alone or in combination with distal ulnar fracture. Details of treatment, radiographic findings, and clinical outcomes during the subsequent orthopedic follow up were recorded.

Results:

Of 124 patients included in the analysis, none required manipulation after their ED visit. All but 14 (11.3%) fractures were angulated ≤20° within the follow-up period. Two (1.6%) fractures that were initially angulated ≤15° progressed to 30°–35°, but remodeled within 2 years to nearly perfect anatomic alignment. By 6 weeks post-injury, no patients had clinically apparent deformity and all had normal function.

Conclusions:

Minimally angulated fractures of the distal metaphyseal radius managed in plaster immobilization without reduction in the ED are unlikely to require future surgical intervention.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

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