Displaced paediatric distal radius fractures--when should we use percutaneous wires?

Abstract

To establish the intra-operative radiographic parameters that predict the need for percutaneous wire fixation to prevent redisplacement following manipulation for displaced paediatric distal radius fractures. A retrospective study of 105 children, assessing pre-, intra- and post-operative radiographs. Optimal reduction was defined as less than 10% residual translation and less than 5° of angulation on anteroposterior and lateral radiographs. Redisplacement was defined as more than 20° angulation or 50% translation on either view. No fracture that was optimally reduced redisplaced. 40% of fractures with suboptimal reduction redisplaced. Initial translation was significantly associated with redisplacement. If our criteria for optimal reduction are met, closed reduction and casting can be confidently employed. If not, percutaneous wires should be employed to avoid redisplacement, especially in cases with a high grade of initial translation.