Marked initial displacement predicts complications in physeal fractures of the distal radius: an analysis of fracture characteristics, primary treatment and complications in 109 patients.

BACKGROUND: Factors predicting redisplacement in the cast and early complications in distal radial physeal injuries have not been analyzed before.

PATIENTS AND METHODS: We analyzed 109 consecutive children with displaced physeal fractures of the distal radius treated by manipulation under anesthesia

RESULTS: Acute carpal tunnel syndrome developed in 2 patients. Posttraumatic swelling necessitating trimming, splitting or removal of the primary circular cast occurred in one-sixth of the patients. Half of the fractures healed in malunion despite an anatomic primary reduction in 85% of the cases. According to logistic regression models, marked initial malposition of the fracture (< 50% displacement or < 20% angulation) was an independent risk factor for complications and redisplacement. Non-anatomic reduction of the fracture was an additional independent risk factor for redisplacement.

INTERPRETATION: The risk of an acute carpal tunnel syndrome should be remembered in patients with marked primary displacement of the fracture. To avoid redislocation, pin fixation of the fracture in patients close to skeletal maturity should be considered if there is a marked initial malposition of the fracture, or if fully anatomic reduction cannot be achieved.