Surgical Outcomes of Displaced Metaphyseal Distal Radius Fractures in Children: A Consecutive Case Series of 100 Patients.

BACKGROUND

Distal radius fractures are among the most common type of fracture seen in the paediatric population. Manipulation under anaesthesia (MUA), with or without Kirschner wire (K-wire) fixation, is the standard treatment for metaphyseal fractures. This study assessed outcomes by fracture type and operative modality.

METHODS

One hundred consecutively surgically treated metaphyseal distal radius fractures in children aged 4-10 years were retrospectively reviewed in our centre. Treatments included MUA with cast alone (MUA/cast) or MUA with K-wire fixation (MUA/K-wire). Fracture type, complications, return to theatre, and time to union/discharge were analysed.

Results

Of 100 patients (46 female, 54 male; mean age 7.4 years), 59 had angulated fractures and 41 had off-ended fractures. 44 (75%) angulated fractures were treated with MUA/cast, while 33 (80%) off-ended fractures were managed with MUA/K-wire. Seven (7%) patients required further surgery for redisplacement. In the off-ended group, redisplacement occurred in two of eight (25%) MUA/cast cases compared with 2 of 33 (6%) MUA/K-wire cases (p=0.16). Overall, K-wire augmentation showed a trend towards reduced risk of re-operation (p=0.059). All fractures united (mean 44.5 days); however, off-ended fractures took significantly longer to heal (p=0.04). Among 48 MUA/K-wire cases, 15 (31%) developed complications, including wire migration, irritation, granulation tissue, hypertrophic scarring, and return for wire removal. Seven malunions remodelled spontaneously, including one from 25° dorsal displacement to normal alignment.

CONCLUSION

Off-ended fractures treated with MUA/cast were more likely to redisplace than those treated with MUA/K-wire, though K-wire fixation carried higher complication rates. Given the excellent remodelling potential in children aged 4-10 years, MUA/cast is recommended where stability can be achieved, as it reduces complications while still allowing reliable remodelling.