Redisplacement of diaphyseal fractures of the forearm after closed reduction in children: a retrospective analysis of risk factors.

Abstract

Manipulation and plaster fixation is the primary management for diaphyseal fractures of the radius and/or ulna in children. This study was designed to evaluate risk factors of fracture redisplacement after closed reduction and cast immobilization. Retrospective study. Tertiary hospital. Fifty-seven children with fractures of the radius were included. The medical records of patients with/without ulna treated with closed reduction and casting were reviewed. Data analyzed were age, sex, dominant hand, fracture pattern, reduction quality, experience of the surgeon, and type of anesthesia. Logistic regression was used for multivariate analysis. There were 41 (71.9%) males and 16 (28.1%) females with a mean age of 9.74 ± 3.07 years. There were 53 radius fractures and 54 ulna fractures, and 22 subjects experienced redisplacement. The redisplacement rate of radius fractures was 34% and of ulnar fractures was 27.8%. Multivariate analysis showed that the factors associated with redisplacement of radius fractures were fair reduction quality [odds ratio (OR), 8.45] and complete fracture (OR 9.62) and those for redisplacement of ulna fractures were fair reduction quality (OR 8.10) and complete fracture (OR 8.43). Poorer reduction and complete fracture are more likely to result in redisplacement, and surgical management may be considered in these cases.