Treatment of children with fractures of the distal metaepiphysis of the radius: A literature review

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: Fractures of the distal metaepiphysis of the radius are among the most common injuries in pediatric patients. This results from the peculiarities of the anatomical structure and structure of the radial tissue in this area.

AIM: This study aimed to analyze the literature on the treatment of children with fractures of the distal metaepiphysis of the radius.

MATERIALS AND METHODS: Literatures on the treatment of children with fractures of the distal metaepiphysis of the radius were extracted from PubMed, eLibrary, and Google Scholar without language restrictions for the period from 1990 to 2024.

RESULTS: In fractures of the distal metaepiphysis of the radius without displacement, the limb is immobilized. Displaced fractures require closed reduction and/or surgical treatment. For the treatment of stable fractures, specialists adhere to conservative techniques. The method of choice for the surgical treatment of unstable fractures should be minimally invasive osteosynthesis. The current gold standard for the surgical treatment of fractures of the distal metaepiphysis of the radius in children is closed reduction and intramedullary metal osteosynthesis with Kirschner wires, followed by plaster cast application.

CONCLUSIONS: Currently, no consensus has been reached on the method of choice for the surgical treatment of fractures of the distal metaepiphysis of the radius in children. The results of treating children using the presented surgical techniques are contradictory, and high risks of developing intra- and postoperative complications are noted. Thus, conducting more research in this area and developing new and most effective surgical methods that can reduce the risk of complications and optimize the rehabilitation process for these patients remain relevant.

Full Text

Restricted Access

About the authors

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

Gleb A. Bolshakov

Irkutsk Municipal Pediatric Clinical Hospital

Author for correspondence.
Email: bolgleb@mail.ru
ORCID iD: 0000-0002-7325-5528

MD

Russian Federation, Irkutsk

References

  1. de Putter CE, van Beeck EF, Looman CW, et al. Trends in wrist fractures in children and adolescents, 1997–2009. J Hand Surg Am. 2011;36(11):1810–1815. doi: 10.1016/j.jhsa.2011.08.006
  2. Qiu X, Deng H, Su Q, et al. Epidemiology and management of 10,486 pediatric fractures in Shenzhen: experience and lessons to be learnt. BMC Pediatrics. 2022;22(1):161. doi: 10.1186/s12887-022-03199-0
  3. Shah AS, Guzek RH, Miller ML, et al. Descriptive epidemiology of isolated distal radius fractures in children: results from a prospective multicenter registry. J Pediatr Orthop. 2023;43(1):e1–e8. doi: 10.1097/BPO.0000000000002288
  4. Jerrhag D, Englund M, Petersson I, et al. Increasing wrist fracture rates in children may have major implications for future adult fracture burden. Acta Orthop. 2016;87(3):296–300. doi: 10.3109/17453674.2016.1152855
  5. Deng H, Zhao Z, Xiong Z, et al. Clinical characteristics of 1124 children with epiphyseal fractures. BMC Musculoskelet Disord. 2023;24(1):598. doi: 10.1186/s12891-023-06728-9
  6. Khasanova NA. Innovative method of treatment of fractures of the distal radius. Cheboksary: Sreda; 2022. EDN: MRNCGE doi: 10.31483/a-10446
  7. Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. NY: Springer; 1990. doi: 10.1007/978-3-642-61261-9
  8. Fernandez DL. Fractures of the distal radius: operative treatment. Instr Course Lect. 1993;42:73–88.
  9. Levine RH, Thomas A, Nezwek TA, et al. Salter-Harris fracture. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing, 2024. Available from: https://pubmed.ncbi.nlm.nih.gov/28613461/ Accessed: Jun 1, 2024.
  10. Firth GB, Robertson AJF. Treatment of distal radius metaphyseal fractures in children: a case report and literature review. South African Orthop J. 2017;16(4):59–63. doi: 10.17159/2309-8309/2017/v16n4a10
  11. Chung R, Foster BK, Xian CJ. Preclinical studies on mesenchymal stem cell-based therapy for growth plate cartilage injury repair. Stem Cells Int. 2011;2011. doi: 10.4061/2011/570125
  12. Zhila NG, Zorin VI. Traumatology of childhood: textbook. Moscow: GEOTAR-Media; 2020. EDN: MHYGIC doi: 10.33029/9704-5819-8-TDV-2020-1-128
  13. Shved SI, Nasyrov MZ. Transosseous osteosynthesis in the system of treating injuries of epiphyseal growth plate in children. Orthopaedic Genius. 2013;(1):9–13. EDN: PWZWMD
  14. Rai P, Haque A, Abraham A. A systematic review of displaced paediatric distal radius fracture management: plaster cast versus Kirschner wiring. J Clin Orthop Trauma. 2020;11(2):275–280. doi: 10.1016/j.jcot.2019.03.021
  15. Fernandez DL, Jupiter JB. Fractures of the distal radius. New York: Springer-Verlag; 1996.
  16. Kubiak R, Aksakal D, Weiss C, et al. Is there a standard treatment for displaced pediatric diametaphyseal forearm fractures?: a STROBE-compliant retrospective study. Medicine (Baltimore). 2019;98(28). doi: 10.1097/MD.0000000000016353
  17. Pannu GS, Herman M. Distal radius-ulna fractures in children. Orthop Clin North Am. 2015;46(2):235–248. doi: 10.1016/j.ocl.2014.11.003
  18. Sinikumpu JJ, Nietosvaara Y. Treatment of distal forearm fractures in children. Scand J Surg. 2021;110(2):276–280. doi: 10.1177/1457496920983104
  19. Nietosvaara Y, Hasler C, Helenius I, et al. Marked initial displacement predicts complications in physeal fractures of the distal radius: an analysis of fracture characteristics, primary treatment and complications in 109 patients. Acta Orthop. 2005;76(6):873–877. doi: 10.1080/17453670510045525
  20. Jeroense KTV, America T, Witbreuk MMEH, et al. Malunion of distal radius fractures in children: remodeling speed in 33 children with angular malunions of ≥ 15 degrees. Acta Orthop. 2015;86(2):233–237. doi: 10.3109/17453674.2014.981781
  21. Flynn JM, Skaggs DL, Waters PM. Rockwood and Wilkins fractures in children. Eighth Edition. LWW; 2014.
  22. Naik P. Remodelling in children’s fractures and limits of acceptability. Indian J Orthop. 2021;55:549–559. doi: 10.1007/s43465-020-00320-2
  23. Plánka L, Chalupová P, Skvaril J, et al. Remodelling ability of the distal radius in fracture healing in childhood. Rozhl Chir. 2006;85(10):508–510.
  24. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146–156. doi: 10.5435/00124635-199805000-00002
  25. Syurahbil AH, Munajat I, Mohd EF, et al. Displaced physeal and metaphyseal fractures of distal radius in children. Can wire fixation achieve better outcome at skeletal maturity than cast alone? Malaysian Orthop J. 2021;14(2):28–38. doi: 10.5704/MOJ.2007.008
  26. Akar D, Köroğlu C, Erkus S, et al. Conservative follow-up of severely displaced distal radial metaphyseal fractures in children. Cureus. 2018;10(9). doi: 10.7759/cureus.3259
  27. Pavone V, Vescio A, Lucenti L, et al. Analysis of loss of reduction as risk factor for additional secondary displacement in children with displaced distal radius fractures treated conservatively. Orthop Traumatol Surg Res. 2020;106(1):193–198. doi: 10.1016/j.otsr.2019.10.013
  28. Persiani P, Martini L, Calogero V, et al. Analysis of the risk of a secondary displacement in conservatively treated paediatric distal radius metaphyseal fractures. A multicentric study. Clin Ther. 2022;173(1):84–87. doi: 10.7417/CT.2022.2397
  29. Marson BA, Ng JWG, Craxford S, et al. Treatment of completely displaced distal radial fractures with a straight plaster or manipulation under anaesthesia. Bone Joint J. 2021;103(5):902–907. doi: 10.1302/0301-620X.103B.BJJ-2020-1740.R1
  30. Abulsoud MI, Mohammed AS, Elmarghany M, et al. Intramedullary Kirschner wire fixation of displaced distal forearm fractures in children. BMC Musculoskelet Disord. 2023;24(1):746. doi: 10.1186/s12891-023-06875-z
  31. Zamzam MM, Khoshhal KI. Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction. J Bone Joint Surg Br. 2005;87(6):841–843. doi: 10.1302/0301-620X.87B6.15648
  32. Jordan RW, Westacott D, Srinivas K, et al. Predicting redisplacement after manipulation of paediatric distal radius fractures: the importance of cast moulding. Eur J Orthop Surg Traumatol. 2015;25(5):841–845. doi: 10.1007/s00590-015-1627-0
  33. Wendling-Keim DS, Wieser B, Dietz HG. Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children? Eur J Trauma Emerg Surg. 2015;41(4):421–428. doi: 10.1007/s00068-014-0483-7
  34. Aladraj TH, Keshta AS, Mukhtar I, et al. A retrospective cohort study comparing the outcomes of conservative versus operative fixation of distal radius fractures in children. Cureus. 2022;14(2). doi: 10.7759/cureus.22544
  35. Wollkopf ADP, Halbeisen FS, Holland-Cunz SG, et al. Diametaphyseal distal forearm fractures in children: a STROBE compliant comparison of outcomes of different stabilization techniques regarding complications. Children. 2023;10(2):374. doi: 10.3390/children10020374
  36. Hang JR, Hutchinson AF, Hau RC. Risk factors associated with loss of position after closed reduction of distal radial fractures in children. J Pediatr Orthop. 2011;31(5):501–506. doi: 10.1097/BPO.0b013e31821fffc3
  37. Sengab A, Krijnen P, Schipper IB. Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis. Eur J Trauma Emerg Surg. 2020;46(4):789–800. doi: 10.1007/s00068-019-01227-w
  38. Pretell Mazzini J, Beck N, Brewer J, et al. Distal metaphyseal radius fractures in children following closed reduction and casting: can loss of reduction be predicted? Int Orthop. 2012;36(7):1435–1440. doi: 10.1007/s00264-012-1493-x
  39. Korobejnikov AA, Popkov DA. Intramedullary elastic stable osteosynthesis in treatment of forearm bone shaft fractures in children. Orthopaedic Genius. 2013;(1):14–18. EDN: PWZWMN
  40. Jozsa G, Devecseri G, Vajda P, et al. Distance of the fracture from the radiocarpal surface in childhood: does it determine surgical technique? A retrospective clinical study: a STROBE compliant observational study. Medicine (Baltimore). 2020;99(7). doi: 10.1097/MD.0000000000017763
  41. Jordan RW, Westacott DJ. Displaced paediatric distal radius fractures – when should we use percutaneous wires? Injury. 2012;43(6):908–911. doi: 10.1016/j.injury.2012.01.006
  42. Kutepov SM, Volokitina EA, Gilev MV, et al. Diagnosis and treatment of fractures of the distal epimetaphysis of the radius. Ekaterinburg: UGMU; 2015. (In Russ.)
  43. Sato O, Aoki M, Kawaguchi S, et al. Antegrade intramedullary K-wire fixation for distal radial fractures. J Hand Surg Am. 2002;27(4):707–713. doi: 10.1053/jhsu.2002.34371
  44. Awasthi A, Jadhav S, Taywade S, et al. Outcome analysis of distal end radius fractures managed with antegrade intramedullary K-wire fixation. Cureus. 2022;14(10). doi: 10.7759/cureus.30512
  45. Mostafa MF. Treatment of distal radial fractures with antegrade intra-medullary Kirschner wires. Strategies Trauma Limb Reconstr. 2013;8(2):89–95. doi: 10.1007/s11751-013-0161-z
  46. Keshava NK, Gedam PN, Mhaisane S, et al. Is antegrade K-wire pinning better than retrograde pinning for distal radius fracture? A comparative study. Int J Res Orthop. 2022;8(6):636–641. doi: 10.18203/issn.2455-4510.IntJResOrthop20222700
  47. Wasiak M, Piekut M, Ratajczak K, et al. Early complications of percutaneous K-wire fixation in pediatric distal radius fractures – a prospective cohort study. Arch Orthop Trauma Surg. 2023;143(11):6649–6656. doi: 10.1007/s00402-023-04996-7
  48. Zeng ZK, Liang WD, Sun YQ, et al. Is percutaneous pinning needed for the treatment of displaced distal radius metaphyseal fractures in children?: a systematic review. Medicine. 2018;97(36). doi: 10.1097/MD.0000000000012142
  49. Turner RG, Faber KJ, Athwal GS. Complications of distal radius fractures. Orthop Clin North Am. 2007;38(2). doi: 10.1016/j.ocl.2007.02.002
  50. Passiatore M, De Vitis R, Perna A, et al. Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing epibloc system and K-wire pinning. Eur J Orthop Surg Traumatol. 2020;30(7):1243–1250. doi: 10.1007/s00590-020-02698-z
  51. van der Sluijs JA, Bron JL. Malunion of the distal radius in children: accurate prediction of the expected remodeling. J Child. Orthop. 2016;10(3):235–240. doi: 10.1007/s11832-016-0741-9
  52. Scharf M, Walter N, Rupp M, et al. Treatment of fracture-related infections with bone abscess formation after K-wire fixation of pediatric distal radius fractures in adolescents – a report of two clinical cases. Children (Basel). 2023;10(3):581. doi: 10.3390/children10030581
  53. Bukvić N, Marinović M, Bakota B, et al. Complications of ESIN osteosynthesis – experience in patients. Injury. 2015;46:40–43. doi: 10.1016/j.injury.2015.10.042
  54. Nisar A, Bhosale A, Madan SS, et al. Complications of elastic stable intramedullary nailing for treating paediatric long bone fractures. J Orthop. 2013;10(1):17–24. doi: 10.1016/j.jor.2013.01.003
  55. Brooker B, Harris PC, Donnan LT, et al. Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children. J Child Orthop. 2014;8:353–357. doi: 10.1007/s11832-014-0605-0
  56. Du M, Han J. Antegrade elastic stable intramedullary nail fixation for paediatric distal radius diaphyseal metaphyseal junction fractures: a new operative approach. Injury. 2019;50(2):598–601. doi: 10.1016/j.injury.2019.01.001
  57. Yang L, Wang S, Xu J, et al. Clinical outcomes of minimally invasive fixation with pre-bent elastic stable intramedullary nails for the treatment of distal radius metaphyseal diaphysis junction fractures in children. Orthop Surg. 2023;15(12):3223–3230. doi: 10.1111/os.13919
  58. Loskutov OE, Makarov VB. Stable functional osteosynthesis of fractures of the distal radius. Ortopedics, traumatology. 2004;(2):57–58. (In Russ.)
  59. Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg. 2014;99(3):269–275. doi: 10.9738/INTSURG-D-13-00065.1
  60. Semenkin OM. Surgical treatment of patients with fractures of the distal metaepiphysis of the radius. N.N. Priorov Journal of Traumatology and Orthopedics. 2010;(4):84–89. EDN: NBRJDV (In Russ.)
  61. Wu R, Wen Y, Wang C, et al. Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal-diaphyseal junction fractures of the distal radius: a case-control study. BMC Musculoskelet Disord. 2023;24(1):922. doi: 10.1186/s12891-023-07055-9
  62. Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg. 2010;20(6):395–398. doi: 10.1055/s-0030-1262843

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Эко-Вектор


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies