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Outcomes and Complications Associated with Pediatric and Adolescent Distal Radius Fractures Managed with Closed Reduction and Percutaneous Pinning
Joshua M Abzug, MD
1; Peyton Woodward, BS
21University of Maryland School of Medicine, Baltimore, MD; 2University of Maryland School of Medicine, Hunt Valley, MD
Introduction Distal radius fractures are the most common fracture in the pediatric population, accounting for approximately 20-30% of all pediatric fractures. These fractures are often managed nonoperatively with immobilization with or without a closed reduction. However, if the fracture is displaced and/or closed reduction cannot be achieved in the emergency department/outpatient setting, operative intervention may be warranted. The typical first choice of operative intervention is closed reduction with or without percutaneous pinning (CRPP). The purpose of this study is to investigate the outcomes and complications of pediatric distal radius fractures that underwent CRPP.
Methods A retrospective review was performed to identify all pediatric and adolescent patients aged 0-17 years who underwent CRPP of a distal radius fracture. Data collected included patient demographics, mechanism of injury, concomitant injuries, post operative immobilization, outcomes, and complications. Complications were categorized as either major or minor complications. Major complications included physeal bar formation or physeal arrest, ulnar nerve palsy, and subsequent refracture. Minor complications included tenderness to palpation, pyogenic granuloma at the pin sites, erosion/eschar of skin at the pin sites, rash, pins backing out, scar hypersensitivity, mild swelling, stiffness, and decreased sensation. Simple statistical analysis was performed.
Results 244 patients with an average age of 10.1 years were identified. The most common mechanism of injury was a fall on an outstretched hand (71.2%). 107 (43.9%) patients sustained concomitant injuries, of which 92.5% were a concomitant ulna fracture. Most patients were placed in a long arm cast (91.7%) postoperatively with an average length of immobilization of 37.7 days. 77 patients (31.6%) experienced a complication following CRPP of a distal radius fracture with 68 (88.3%) patients experiencing a minor complication and 9 (11.7%) patients experiencing a major complication. Those major complications included physeal bar formation or physeal arrest (n=7), ulnar nerve palsy (n=1), and subsequent refracture (n=1). Minor complications included erosion of skin or eschar at the pin sites (n=17), pyogenic granuloma at the pin sites (n=15), tenderness to palpation (n=14), decreased sensation (n=8), stiffness (n=4), hypersensitivity (n=3), rash (n=3), mild swelling (n=3), and pins backing out (n=2).
Conclusions Pediatric distal radius fractures managed operatively with closed reduction and percutaneous pinning are associated with a high rate of minor complications. The risk of physeal arrest associated with CRPP of distal radius fractures is 2.9% (7/244). Future studies are needed to better evaluate the CRPP of distal radius fracture technique in hopes of decreasing the complication rate.
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