TY - JOUR
T1 - Distal Radius Salter-Harris II Fracture Loss of Reduction
T2 - The Importance of Coronal Plane Angulation in Older Children
AU - Rivera, Asdrubal E.
AU - Welbeck, Arakua
AU - Cummings, Jason L.
AU - Goldfarb, Charles A.
AU - Hosseinzadeh, Pooya
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objectives:To assess factors affecting the loss of reduction (LOR) in a large cohort of children with Salter-Harris Type II (SH II) distal radius physeal fractures treated with closed reduction.Design:Retrospective chart review.Setting:Pediatric Level I Trauma Center.Patients/Participants:A total of 141 pediatric patients (73% male, average age: 12.15 ± 2.55 years) that had undergone closed reduction and casting for distal radius physeal fractures from 2006 to 2019 were included in this study.Intervention:Closed reduction and casting.Main Outcome Measurements:Five different radiographic measurements were analyzed at 4 different time points. Follow-up radiographs were assessed in relation to initial reduction. LOR was defined as >5 degrees change of angulation on PA radiographs, >10 degrees change of angulation on lateral radiographs, and/or >25% translation on PA or lateral radiographs.Results:LOR was seen in 28.4% of the patients, most often (68%) in the first 2 weeks after initial reduction. Seven (17.5%) of these patients (average age: 15.2 ± 2.0 years) were treated surgically with closed reduction and percutaneous pinning (CRPP). Patients undergoing CRPP for LOR were an average of 3.4 years older (P < 0.001) than those who underwent nonoperative treatment of LOR. Patients with initial angulation more than 5 degrees on the PA view to be twice as likely to have LOR (P = 0.03).Conclusions:LOR was seen in nearly 1/3 of these patients. Patients with initial higher degree of angulation on the coronal plane are at higher risk for LOR. Age, not the degree of angulation, is the main predictor for potential surgical treatment.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Objectives:To assess factors affecting the loss of reduction (LOR) in a large cohort of children with Salter-Harris Type II (SH II) distal radius physeal fractures treated with closed reduction.Design:Retrospective chart review.Setting:Pediatric Level I Trauma Center.Patients/Participants:A total of 141 pediatric patients (73% male, average age: 12.15 ± 2.55 years) that had undergone closed reduction and casting for distal radius physeal fractures from 2006 to 2019 were included in this study.Intervention:Closed reduction and casting.Main Outcome Measurements:Five different radiographic measurements were analyzed at 4 different time points. Follow-up radiographs were assessed in relation to initial reduction. LOR was defined as >5 degrees change of angulation on PA radiographs, >10 degrees change of angulation on lateral radiographs, and/or >25% translation on PA or lateral radiographs.Results:LOR was seen in 28.4% of the patients, most often (68%) in the first 2 weeks after initial reduction. Seven (17.5%) of these patients (average age: 15.2 ± 2.0 years) were treated surgically with closed reduction and percutaneous pinning (CRPP). Patients undergoing CRPP for LOR were an average of 3.4 years older (P < 0.001) than those who underwent nonoperative treatment of LOR. Patients with initial angulation more than 5 degrees on the PA view to be twice as likely to have LOR (P = 0.03).Conclusions:LOR was seen in nearly 1/3 of these patients. Patients with initial higher degree of angulation on the coronal plane are at higher risk for LOR. Age, not the degree of angulation, is the main predictor for potential surgical treatment.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
KW - Salter-Harris type II
KW - closed reduction and casting
KW - fracture
KW - wrist
UR - http://www.scopus.com/inward/record.url?scp=85164844728&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000002599
DO - 10.1097/BOT.0000000000002599
M3 - Article
C2 - 36952599
AN - SCOPUS:85164844728
SN - 0890-5339
VL - 37
SP - 417
EP - 422
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 8
ER -