Radius Fractures Clinical Trial
Official title:
Management of Distal Radius Fractures in Children Younger Than 11 Years Old. Comparison Between Two Groups
This fractures have been managed with anatomical reduction performed under anesthesia or using sedatives. In our institution this means prolonged hospital stay, involvement of an anesthesiologist and the use of an special room in the Emergency Department. This research protocol was born after reports were published regarding leaving the fractures in an overriding position and cast with good functional and acceptable radiographical results; said study was observational, providing valuable but limited information about this treatment option. On the other hand, our study is a randomized controlled trial between to groups of patients younger than 11 years old who presented to the Emergency Department with completely displaced distal radius fractures, they were randomly assigned to one of two groups, either a closed anatomic reduction and short cast or a closed overriding alignment and short cast.
Distal radius fractures represent up to 40% of all fractures in pediatric patients, with the
most common mechanism being simple falls with the hand and wrist in extension. The standard
treatment for this kind of fractures is a closed anatomical reduction and placing a short arm
cast for 6 week, with a weekly follow-up paying close attention to re-displacement and
consolidation data. This fractures have acceptable deformity angles after the anatomical
reduction of up to 15º in the coronal and sagittal plane; in order to perform this reduction,
the patient is subject to a sedation under strict monitorization, either in the Emergency
Department or in the Surgical Room. In most cases, the patient must stay in the hospital for
at least 3 hours after the procedure was performed, in order to be discharged with analgesics
and appropriate indications for caring a cast in home.
Distal radius fractures in pediatric patients have been managed with anatomical reduction
performed under anesthesia or using sedatives. In our institution this means prolonged
hospital stay, involvement of an anesthesiologist and the use of aa special room in the
Emergency Department. This research protocol was born after reports were published regarding
leaving the fractures in an overriding position and cast with good functional and acceptable
radiographical results; said study was observational, providing valuable but limited
information about this treatment option. On the other hand, our study is a randomized
controlled trial between to groups of patients younger than 11 years old who presented to the
Emergency Department with completely displaced distal radius fractures, they were randomly
assigned to one of two groups, either a closed anatomic reduction and short cast or a closed
overriding alignment and short cast.
Recent studies have suggested an alternative option for this patients, in which instead of
performing a complete reduction, a gentle maneuver is done in order to get partial alignment
or overriding fracture, with an strict follow-up and cooperative patients, this method has
shown good results in terms of consolidation and deformity angles. The new procedure is
performed without anesthesia, instead non-steroid antiinflammatory and analgesics are given
to the patient, giving the possibility of an early discharge.
The possibility of leaving the patient with an overriding position and having good results is
related to recent studies about bone in pediatric patients, especially in those younger than
14 years old. The published observations presume that fracture consolidation and remodeling
potential is given by physis presence and the persistence throughout the years. Even more
importantly, it is now known that the distal radius is predominantly formed by trabecular
bone and a thicker periosteum, conditions that confer this bone a higher consolidation rate
and rapid remodeling, leaving permanent deformities and reinterventions as rather rare
situations. In terms of aesthetic deformities, 20º of radiological deformity in any plane is
required to leave a clinically visible deformity, and even more so, 35º are needed to cause a
functional impairment.
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