Management of Distal Radius Fractures in Children Younger Than 11 Years Old.
Condition: Bone Fractures; Radius Fractures; Closed Fractures
MeSH terms: Fractures, Bone; Radius Fractures; Wrist Fractures; Fractures, Closed
Study type: Interventional

Summary: 
      This fractures have been managed with anatomical reduction performed under anesthesia or
      using sedatives. In our institution this means prolonged hospital stay, involvement of an
      anesthesiologist and the use of an special room in the Emergency Department. This research
      protocol was born after reports were published regarding leaving the fractures in an
      overriding position and cast with good functional and acceptable radiographical results; said
      study was observational, providing valuable but limited information about this treatment
      option. On the other hand, our study is a randomized controlled trial between to groups of
      patients younger than 11 years old who presented to the Emergency Department with completely
      displaced distal radius fractures, they were randomly assigned to one of two groups, either a
      closed anatomic reduction and short cast or a closed overriding alignment and short cast.
    

Detailed description: 
      Distal radius fractures represent up to 40% of all fractures in pediatric patients, with the
      most common mechanism being simple falls with the hand and wrist in extension. The standard
      treatment for this kind of fractures is a closed anatomical reduction and placing a short arm
      cast for 6 week, with a weekly follow-up paying close attention to re-displacement and
      consolidation data. This fractures have acceptable deformity angles after the anatomical
      reduction of up to 15º in the coronal and sagittal plane; in order to perform this reduction,
      the patient is subject to a sedation under strict monitorization, either in the Emergency
      Department or in the Surgical Room. In most cases, the patient must stay in the hospital for
      at least 3 hours after the procedure was performed, in order to be discharged with analgesics
      and appropriate indications for caring a cast in home.

      Distal radius fractures in pediatric patients have been managed with anatomical reduction
      performed under anesthesia or using sedatives. In our institution this means prolonged
      hospital stay, involvement of an anesthesiologist and the use of aa special room in the
      Emergency Department. This research protocol was born after reports were published regarding
      leaving the fractures in an overriding position and cast with good functional and acceptable
      radiographical results; said study was observational, providing valuable but limited
      information about this treatment option. On the other hand, our study is a randomized
      controlled trial between to groups of patients younger than 11 years old who presented to the
      Emergency Department with completely displaced distal radius fractures, they were randomly
      assigned to one of two groups, either a closed anatomic reduction and short cast or a closed
      overriding alignment and short cast.

      Recent studies have suggested an alternative option for this patients, in which instead of
      performing a complete reduction, a gentle maneuver is done in order to get partial alignment
      or overriding fracture, with an strict follow-up and cooperative patients, this method has
      shown good results in terms of consolidation and deformity angles. The new procedure is
      performed without anesthesia, instead non-steroid antiinflammatory and analgesics are given
      to the patient, giving the possibility of an early discharge.

      The possibility of leaving the patient with an overriding position and having good results is
      related to recent studies about bone in pediatric patients, especially in those younger than
      14 years old. The published observations presume that fracture consolidation and remodeling
      potential is given by physis presence and the persistence throughout the years. Even more
      importantly, it is now known that the distal radius is predominantly formed by trabecular
      bone and a thicker periosteum, conditions that confer this bone a higher consolidation rate
      and rapid remodeling, leaving permanent deformities and reinterventions as rather rare
      situations. In terms of aesthetic deformities, 20º of radiological deformity in any plane is
      required to leave a clinically visible deformity, and even more so, 35º are needed to cause a
      functional impairment.
    

Intervention name(s): Partial reduction with overriding position; Closed anatomic reduction
Intervention type(s): Procedure; Procedure
Intervention description(s): The patient was subjected to an alignment instead of an anatomic reduction; this means that the fracture was left in an overriding position, after this, the patient was placed in a short arm cast for 6 weeks.; The patient was subjected to an anatomic reduction; this means that the fracture was completely reduced, after this, the patient was placed in a short arm cast for 6 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pediatric orthopedics