Risk stratification for failure of conservative treatment in a cohort of 270 diametaphyseal radius fractures.

BACKGROUND

Diametaphyseal radius fractures (DMRF) in children pose a challenge to pediatric traumatologists. Numerous techniques to address the problems of conventional osteosynthesis have been published. Still, immobilization in a cast is the treatment of choice in most cases. The aim of this study was to assess risk factors for the failure of conservative treatment in DMRFs.

METHODS

This is a single-center, retrospective study of 270 patients with conservatively treated DMRFs. Demographic data and radiologic fracture characteristics were assessed. Univariate and multivariate regression analyses were performed to identify risk factors for secondary dislocation, refracture, or secondary osteosynthesis. Significant variables were included in a risk prediction model.

RESULTS

Secondary dislocation, refracture, and secondary osteosynthesis occurred in 10.0%, 5.6%, and 11.0%, respectively. Increasing angles of the fracture line, severe angulation, and greenstick fractures were identified to significantly predict either one of these complications. Surprisingly, proximal DMRFs with an increased forearm fracture index were less likely to dislocate secondarily.

CONCLUSIONS

Conservatively treated DMRFs with severe angulation, tilted fracture lines, and greenstick fractures are more likely to suffer complications. Hence, these fractures should be stabilized with osteosynthesis primarily. The introduced risk prediction tools should be validated prospectively.