Remodelling Ability of the Distal Radius in Fracture Healing in Childhood

Overview

Introduction:
Distal forearm fractures are among the commonest skeletal injuries in childhood. The aim of this work is to analyze factors determining remodelling abilities of the distal radial metaphysis in dislocated fractures, considering a requirement for eventual non-operative repositining.

Material and Methodology:
The primary patient group included a group of patients treated in 2004 for distal radial metaphysis fractures, left to heal in a dislocated position. The angle of dislocation ranged from 8 to 30 degrees. All patients underwent a follow up x-ray examination 2, or more, years later and a clinical examination of the wrist joint range of motion. The extent of remodellation was studied, considering duration of the healing process, patient’s age and the fracture line distance from the growth plate.

Results:
The results show that in the majority of the patients included in the study, complete remodellation of the radius nearly to its anatomical position (86%) occurred. The results were significantly better in the patient group aged 0–12 years. Furthermore, significantly less residual dislocations were recorded within 20mm from the growth plate. Restriction of the wrist joint range of motion resulting from residual dislocation was not recorded.

Conclusion:
Based on the results, conservative treatment of the condition, especially in cases of multiple injuries or of a polytrauma, is recommended. Also, in cases of deterioration of the positioning or of redislocation after repositioning, repositioning need not be repeated in patients below 12 year of age.

Key words:
radius – remodellation – childhood – fracture