Quantitative Assessment of Displacement, Angulation and Shortening in Paediatric Distal Radius Fractures: Implications for Treatment Modality and Functional Outcomes
Nandakumar Natarajan *
Kauvery Hospital, Radial Road, Kovilambakkam, Chennai – 600 129, Tamil Nadu, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Distal radius fractures are among the most common paediatric orthopedic injuries, with closed reduction and cast immobilization being the primary treatment. However, fracture re-displacement rates range from 25–39%, often necessitating surgical intervention. The role of preoperative radiographic measurements in predicting closed reduction failure remains underexplored. This study quantitatively assesses displacement, angulation, and shortening in paediatric distal radius fractures to evaluate their impact on treatment modality and functional outcomes.
Place and Duration of Study: Department of Orthopedics, Kauvery Hospital, Radial Road, Chennai, India between June 2023 and July 2024.
Methods: A retrospective analysis of 22 paediatric patients (ages 5–15) with completely displaced distal radius fractures was conducted. Patients were categorized into two groups: Group I (n = 14) underwent successful closed reduction and internal fixation, while Group II (n = 8) required open reduction and internal fixation due to failed closed reduction. Radiographic parameters—including radial shortening, displacement, and dorsal angulation—were assessed at three time points: preoperatively, postoperatively, and at implant removal. Functional outcomes were evaluated using the Mayo Wrist Score. Statistical analyses were performed using paired T-tests and Fisher’s Exact test, with significance set at p < 0.05.
Results: Group II exhibited significantly greater preoperative radial shortening (14.4 mm vs. 7.2 mm) and displacement (100% vs. 82%) than Group I. Postoperative radiographic outcomes improved in both groups, with no significant differences in final displacement or radial shortening. However, dorsal angulation at implant removal was higher in Group I (p = 0.03). Both groups demonstrated good functional recovery, though patient satisfaction was higher when implants were buried beneath the skin.
Conclusion: Severe preoperative displacement, shortening, and angulation are strong predictors of closed reduction failure. Identifying cases requiring open reduction early can minimize complications and re-intervention. Future studies should establish standardized radiographic thresholds to optimize treatment decisions and long-term outcomes.
Keywords: Paediatric distal radius fractures, closed reduction failure, internal fixation, preoperative radiographic assessment, functional outcomes