ABSTRACT
AIMS: The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of 'off-ended' fractures in children with at least two years of potential growth remaining. METHODS: A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires. RESULTS: Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections. CONCLUSION: Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy. Cite this article: Bone Joint J 2021;103-B(5):902-907.
Subject(s)
Anesthesia/methods , Casts, Surgical , Fracture Fixation/methods , Manipulation, Orthopedic , Radius Fractures/therapy , Bone Wires , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Radius Fractures/diagnostic imagingABSTRACT
Hallux valgus in children is a relatively uncommon deformity, also known by several other names such as juvenile or adolescent bunion, metatarsus primus varus, and metatarsus primus adductus. The presence of an open growth plate is considered by most to be part of the definition of this condition. However, others include patients up to age 20 years, owing to the plastic nature of the various components of the condition. The presenting complaint is invariably of the bunion and its cosmetic appearance. Treatment should be conservative and surgery avoided till skeletal maturity is achieved due to the high incidence of recurrence in children.
