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Outcomes and Complications Following Open Reduction Internal Fixation of Pediatric and Adolescent Distal Radius Fractures
Anisha Pancholi, BS
1, Julia L Conroy, BS
1, Catherine C May, BS
2; Joshua M Abzug, MD
3(1)University of Maryland School of Medicine, Hunt Valley, MD, (2)University of Maryland School of Medicine, Timonium, MD, (3)University of Maryland School of Medicine, Baltimore, MD
Introduction:
Distal radius fractures are one of the most common fractures in the pediatric and adolescent populations. The majority of these fractures are treated nonoperatively with immobilization, however, fractures with substantial displacement and/or angulation warrant further operative intervention. While closed reduction and percutaneous pinning (CRPP) is the initial operative procedure attempted in the vast majority of cases, at times a closed reduction is not possible and therefore an open reduction with internal fixation is performed. Literature surrounding outcomes and complications of pediatric distal radius fractures treated with open reduction and internal fixation (ORIF) is limited. The purpose of this study is to assess outcomes and complications of pediatric distal radius fractures after ORIF.
Materials & Methods:
A retrospective chart review was conducted to identify pediatric and adolescent patients 0-17 years of age who underwent treatment for a distal radius fracture with an open reduction and internal fixation (ORIF). Data collected included patient demographics, mechanism of injury, concomitant injuries, fracture location (extraphyseal/extra articular vs. physeal or intraarticular), type of hardware used for fixation, immobilization type, length of immobilization, and complications. Simple statistical analysis was conducted.
Results:
36 patients with an average age of 9.3 years were identified. The most common mechanisms of injury were fall on an outstretched hand (37%) and a fall off of a bike or scooter (37%). The majority of fractures were classified as extraphyseal (91.4%), and thus were extra-articular in nature. 12 patients (35.2%) had a concomitant distal ulna fracture. Fixation was most commonly performed with Kirschner wires (30.5%, n=11) followed by plate and screw fixation (22.2%, n=8). Additional hardware utilized for fixation included Steinmann pins and flexible intramedullary nails. The duration until pin/intramedullary flexible nail removal was 61.9 days and the average length of post operative immobilization was 68.0 days. There were no recorded complications associated with patients that underwent ORIF and no reported cases of premature physeal closure.
Conclusions:
Pediatric distal radius fractures with substantial displacement and/or angulation which warrant operative treatment and are unsuccessful with closed reduction techniques can be safely treated with open reduction and internal fixation (ORIF). Excellent outcomes and minimal complications can be expected. ORIF of pediatric and adolescent extraphyseal distal radial fractures is not associated with premature physeal closure.
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