Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial.
In a prospective, randomised controlled trial, 68 children who had a completely displaced metaphyseal fracture of the distal radius were treated either by manipulation (MUA) and application of an above-elbow cast alone or by the additional insertion of a percutaneous Kirschner (K-) wire. Full radiological follow-up to union was obtained in 65 children and 56 returned for clinical evaluation three months after injury. Maintenance of reduction was significantly better in the K-wire group and fewer follow-up radiographs were required. There was no significant difference in the clinical outcome measured three months after injury. Seven of 33 patients in the MUA group had to undergo a second procedure because of an unacceptable position compared with none of the 35 in the K-wire group (chi-squared test, p < 0.01). One patient in the K-wire group required exploration for recovery of a migrated wire. We conclude that the use of a percutaneous K-wire to augment the reduction of the fracture in children who have a completely displaced metaphyseal fracture of the distal radius is a safe and reliable way of maintaining alignment of the fracture.
McLauchlan
G J
GJ
Department of Orthopaedic Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland, UK.
Cowan
B
B
Annan
I H
IH
Robb
J E
JE
D000293:Adolescent; D001864:Bone Wires; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D007103:Immobilization; D008297:Male; D008349:Manipulation, Orthopedic; D011446:Prospective Studies; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D014457:Ulna / Q000000981:diagnostic imaging