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J Orthop Trauma. 2019 Oct;33(10):e378-e384. doi: 10.1097/BOT.0000000000001516.

Pediatric Proximal Radial Shaft Fractures Treated Nonoperatively Fail to Maintain Acceptable Reduction up to 70% of the Time.

Author information

1
Orthopaedic Surgery Department, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Abstract

OBJECTIVE:

To compare early radiographic malalignment rates of conservatively treated proximal radial shaft fractures to more distal fractures.

DESIGN:

Retrospective cohort study.

SETTING:

A pediatric, Level 1 trauma center.

PATIENTS/PARTICIPANTS:

We identified a group of 401 pediatric patients who were treated for a complete radial shaft fracture at our institution. Of this group, 309 patients met our inclusion criteria for attempted nonoperative management and were evaluated in our study.

INTERVENTION:

Closed reduction and casting.

MAIN OUTCOME MEASUREMENT:

The primary outcome of the study was the failure rate of nonoperative management as defined by residual angulation of the radius assessed on follow-up radiographs.

RESULTS:

Proximal third fractures were significantly more likely to fail conservative treatment (P < 0.0001) as they exceeded angulation criteria 70% (32/46) of the time compared with more distal fractures (33%; 87/263). In terms of halves (P = 0.0003), the proximal half fractures failed 50% (55/111) of the time while 29% (57/198) of distal half fractures failed conservative treatment. Failure of closed reduction and casting was 4.6 times higher (95% confidence interval, 2.3-9.1) in proximal third fractures and 2.4 times greater (95% confidence interval, 1.5-3.9) in proximal half fractures compared with their more distal counterparts.

CONCLUSIONS:

Given the impressive rate of failure of closed reduction and casting of proximal third radial shaft fractures, the treating orthopaedic surgeon should prudently consider all management options.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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