Paediatric distal radius fractures: risk factors for redisplacement

Abstract

Background: Redisplacement of paediatric distal radius fractures is a common problem that may require surgical intervention to avoid suboptimal functional outcomes. Several individual risk factors are known to increase the risk for redisplacement. The aim of this study was to explore and evaluate potential risk factors for redisplacement of the distal radius after closed reduction and plaster cast immobilisation.

Methods: A retrospective cohort study included paediatric patients between the ages of 2 and 14 years who presented with distal radius fractures and underwent closed reduction and plaster cast immobilisation. Data was evaluated for patient-, fracture- and treatment-related risk factors for redisplacement. Predictor variables were individually tested against the outcome of redisplacement using univariate logistic regression analysis. A p-value < 0.2 was used to select variables to take forward into a multivariable model, including categorised risk factors.

Results: Redisplacement occurred in 40% (n = 59) of the 146 included patients. Independent factors associated with increased risk for redisplacement included: age < 10 years (p = 0.002), sagittal plane angulation < 20° (p = 0114), a first cast index of > 0.8 (p = 0.002), metaphyseal fractures as opposed to growth plate injuries (p ≤ 0.001), the absence of an associated ulna fracture (p = 0.026), and poor initial reduction (p ≤ 0.001). Three independent variables were finally included into a multivariable model and remained significant risk factors for redisplacement. Poor reduction (risk ratio [RR] 2.5 p < 0.001), metaphyseal fracture location (RR 2.6 p < 0.029), and first cast index > 0.8 (RR 1.3 p < 0.019) collectively influenced the risk of redisplacement.

Conclusion: Analysis of risk factors for redisplacement revealed that poor reduction, metaphyseal injuries and a cast index > 0.8 are associated with an increased risk of redisplacement of distal radius fractures in children.

Level of evidence: Level 3