Minimally angulated pediatric wrist fractures: is immobilization without manipulation enough?
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.


OBJECTIVE
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 degrees 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 degrees within the follow-up period. Two (1.6%) fractures that were initially angulated </=15 degrees progressed to 30 degrees -35 degrees , 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.
Al-Ansari
Khalid
K
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Howard
Andrew
A
Seeto
Brian
B
Yoo
Solina
S
Zaki
Salma
S
Boutis
Kathy
K
D002370:Casts, Surgical; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D008297:Male; D008349:Manipulation, Orthopedic; D011885:Radius Fractures / Q000503:physiopathology / Q000628:therapy*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013165:Splints; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000503:physiopathology / Q000628:therapy