Purpose The therapy of distal radial fractures in children\nis expected to be as non-invasive as possible but also needs\nto deliver the definite care for gaining optimal reduction\nand stabilizing the fracture. Therefore, closed reduction and\nimmobilization is competing with routine Kirschner wire\nfixation. The aim of our study was to investigate if closed\nreduction and immobilization without osteosynthesis can\nensure stabilization of the fracture.\nMethods We chose a retrospective study design and analyzed\n393 displaced distal radial fractures in children from\n1 to 18 years with open epiphyseal plates studying medical\nfiles and X-rays. The Pearsonââ?¬â?¢s ?2 test was applied. Statistical\nanalysis was performed using IBM SPSS Statistics\n20.0. Statistical significance was set at an alpha level of\nP = 0.05.\nResults Of these studied fractures 263 cases were\ntreated with closed reduction and immobilization. Only\n38 of these needed secondary interventions, 28 of these\nunderwent reduction after redisplacement and ten patients\nreceived secondary Kirschner wire fixation. The last\nfollow-up examination after 4ââ?¬â??6 weeks revealed that\n96.4 % of fractures initially treated with closed reduction\nand immobilization were measured within the limits\nof remodeling. 104 of the studied fractures were treated\nwith cast immobilization alone when displacement was\nexpected to correct due to remodeling. Here 22.1 % of\npatients needed secondary reduction. Furthermore, primary\nKirschner wire fixation was performed in only 25 children with unstable fractures and only one received\nfurther treatment. Interestingly, operative reports of primary\nclosed reduction revealed that repeated maneuvers\nof reduction as well as residual displacement are risk factors\nfor redisplacement.\nConclusion For the treatment of displaced distal radial\nfractures in children closed reduction and immobilization\ncan be considered the method of choice. However, for cases\nwith repeated reduction maneuvers or residual displacement\nwe recommend primary Kirschner wire fixation to\navoid redisplacement.
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