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Distal Radius Fractures

  • Ahmed Bazzi
  • Brett Shannon
  • Paul Sponseller
Reference work entry

Abstract

Distal radius fractures are the most common fractures in the pediatric population, with an incidence of 21–31 % of fractures. They commonly occur as a result of a traumatic fall, more commonly in males than females, and their prevalence is on the rise. The pediatric wrist fracture has excellent remodeling potential, as the distal radius physis contributes approximately 80 % of the longitudinal growth of the forearm. The remodeling potential is especially great in the younger patient with more than 2 years of growth remaining.

Clinical examination and radiographic evaluation of the affected limb will reveal the fracture in question. Distal radius fractures are commonly associated with ulnar fractures, either at the same level or at the ulnar styloid. One must assess the joints above and below to rule out a concomitant injury. The soft tissues may reveal signs of an open fracture, compartment syndrome, or vascular compromise. Growth arrest with displaced physeal injuries of the distal radius occurs in 4–5 % of cases, while an ulnar physeal injury can be present in up to 50 % of fractures involving the distal ulnar physis. It is imperative not to miss associated dislocations, including Galeazzi or Monteggia fracture dislocations.

Treatment options include nonoperative immobilization, closed reduction and percutaneous pinning, and open reduction internal fixation. Most non-displaced fractures, Salter-Harris I and II, greenstick, buckle, complete or plastically deformed fractures, are amenable to first-line nonoperative treatment. Surgical treatment is reserved for open fractures, irreducible fractures, fractures with associated neurovascular compromise, presence of excessive swelling, displaced intra-articular fractures, concomitant elbow fractures, polytrauma, fractures that had loss of their initial reduction, and displaced fractures in children nearing skeletal maturity.

Keywords

Distal Radius Closed Reduction Distal Radius Fracture Scaphoid Fracture Ulnar Styloid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 1

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References

  1. Abid A, Accadbled F, Kany J, de Gauzy JS, Darodes P, Cahuzac JP. Ulnar styloid fracture in children: a retrospective study of 46 cases. J Pediatr Orthop B. 2008;17(1):15–9.PubMedCrossRefGoogle Scholar
  2. Al-Ansari K, Howard A, Seeto B, Yoo S, Zaki S, Boutis K. Minimally angulated pediatric wrist fractures: is immobilization without manipulation enough? Can J Emerg Med. 2007;9(1):9–15.Google Scholar
  3. Alemdaroglu KB, Iltar S, Cimen O, Uysal M, Alagoz E, Atlihan D. Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am. 2008;90(6):1224–30.PubMedCrossRefGoogle Scholar
  4. Bae DS, Howard AW. Distal radius fractures: what is the evidence? J Pediatr Orthop. 2012;32 Suppl 2:S128–30.PubMedCrossRefGoogle Scholar
  5. Bae DS, Waters PM. Pediatric distal radius fractures and triangular fibrocartilage complex injuries. Hand Clin. 2006;22(1):43–53.PubMedCrossRefGoogle Scholar
  6. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153–7.PubMedCrossRefGoogle Scholar
  7. Blakemore LC, Cooperman DR, Thompson GH, Wathey C, Ballock RT. Compartment syndrome in ipsilateral humerus and forearm fractures in children. Clin Orthop. 2000;376:32–8.PubMedCrossRefGoogle Scholar
  8. Bohm ER, Bubbar V, Yong Hing K, Dzus A. Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am. 2006;88(1):1–8.PubMedCrossRefGoogle Scholar
  9. Boutis K, Willan A, Babyn P, Goeree R, Howard A. Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial. CMAJ. 2010;182(14):1507–12.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Boyer BA, Overton B, Schrader W, Riley P, Fleissner P. Position of immobilization for pediatric forearm fractures. J Pediatr Orthop. 2002;22(2):185–7.PubMedGoogle Scholar
  11. Chess DG, Hyndman JC, Leahey JL, Brown DC, Sinclair AM. Short arm plaster cast for distal pediatric forearm fractures. J Pediatr Orthop. 1994;14(2):211–13.PubMedCrossRefGoogle Scholar
  12. Chevalley T, Bonjour JP, van Rietbergen B, Ferrari S, Rizzoli R. Fractures during childhood and adolescence in healthy boys: relation with bone mass, microstructure, and strength. J Clin Endocrinol Metab. 2011;96(10):3134–42.PubMedCrossRefGoogle Scholar
  13. Chevalley T, Bonjour JP, van Rietbergen B, Rizzoli R, Ferrari S. Fractures in healthy females followed from childhood to early adulthood are associated with later menarcheal age and with impaired bone microstructure at peak bone mass. J Clin Endocrinol Metab. 2012;97(11):4174–81.PubMedCrossRefGoogle Scholar
  14. Crawford SN, Lee LS, Izuka BH. Closed treatment of overriding distal radial fractures without reduction in children. J Bone Joint Surg Am. 2012;94(3):246–52.PubMedCrossRefGoogle Scholar
  15. Davidson JS, Brown DJ, Barnes SN, Bruce CE. Simple treatment for torus fractures of the distal radius. J Bone Joint Surg Br. 2001;83(8):1173–5.PubMedCrossRefGoogle Scholar
  16. de Putter CE, van Beeck EF, Looman CW, Toet H, Hovius SE, Selles RW. Trends in wrist fractures in children and adolescents, 1997–2009. J Hand Surg Am. 2011;36(11):1810–1815.e2.PubMedCrossRefGoogle Scholar
  17. Denes Jr AE, Goding R, Tamborlane J, Schwartz E. Maintenance of reduction of pediatric distal radius fractures with a sugar-tong splint. Am J Orthop (Belle Mead NJ). 2007;36(2):68–70.Google Scholar
  18. Dhoju D, Shrestha D, Parajuli N, Dhakal G, Shrestha R. Ipsilateral supracondylar fracture and forearm bone injury in children: a retrospective review of thirty one cases. Kathmandu Univ Med J (KUMJ). 2011;9(34):11–6.Google Scholar
  19. Do TT, Strub WM, Foad SL, Mehlman CT, Crawford AH. Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis. J Pediatr Orthop B. 2003;12(2):109–15.PubMedGoogle Scholar
  20. Ducher G et al. Overweight children have a greater proportion of fat mass relative to muscle mass in the upper limbs than in the lower limbs: implications for bone strength at the distal forearm. Am J Clin Nutr. 2009;90(4):1104–11.PubMedCrossRefGoogle Scholar
  21. Edmonds EW, Capelo RM, Stearns P, Bastrom TP, Wallace CD, Newton PO. Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle. J Child Orthop. 2009;3(5):375–81.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Egol KA, Koval KJ, Zuckerman JD. Handbook of fractures. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.Google Scholar
  23. Ehsan A, Stevanovic M. Skeletally mature patients with bilateral distal radius fractures have more associated injuries. Clin Orthop Relat Res. 2010;468(1):238–42.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Eichinger JK, Agochukwu U, Franklin J, Arrington ED, Bluman EM. A new reduction technique for completely displaced forearm and wrist fractures in children: a biomechanical assessment and 4-year clinical evaluation. J Pediatr Orthop. 2011;31(7):e73–9.PubMedCrossRefGoogle Scholar
  25. Faulkner RA, Davison KS, Bailey DA, Mirwald RL, Baxter-Jones AD. Size-corrected BMD decreases during peak linear growth: implications for fracture incidence during adolescence. J Bone Miner Res. 2006;21(12):1864–70.PubMedCrossRefGoogle Scholar
  26. Garcia-Mata S, Hidalgo-Ovejero A. Triplane fracture of the distal radius. J Pediatr Orthop B. 2006;15(4):298–301.PubMedCrossRefGoogle Scholar
  27. Goulding A et al. Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study. J Pediatr. 2001;139(4):509–15.PubMedCrossRefGoogle Scholar
  28. Hafner R, Poznanski AK, Donovan JM. Ulnar variance in children–standard measurements for evaluation of ulnar shortening in juvenile rheumatoid arthritis, hereditary multiple exostosis and other bone or joint disorders in childhood. Skeletal Radiol. 1989;18(7):513–16.PubMedCrossRefGoogle Scholar
  29. Harrington P, Sharif I, Fogarty EE, Dowling FE, Moore DP. Management of floating elbow injury in children. Simultaneous ipsilateral fractures of the elbow and forearm. Arch Orthop Trauma Surg. 2000;120:205–8.PubMedCrossRefGoogle Scholar
  30. Houshian S, Holst AK, Larsen MS, Torfing T. Remodeling of Salter-Harris type II epiphyseal plate injury of the distal radius. J Pediatr Orthop B. 2004;24(5):472–6.CrossRefGoogle Scholar
  31. Hwang RW, Bas de Witte P, Ring D. Compartment syndrome associated with distal radial fracture and ipsilateral elbow injury. J Bone Joint Surg Am. 2009;91:642–5.PubMedCrossRefGoogle Scholar
  32. Kamat AS, Pierse N, Devane P, Mutimer J, Horne G. Redefining the cast index: the optimum technique to reduce redisplacement in pediatric distal forearm fractures. J Pediatr Orthop. 2012;32(8):787–91.PubMedCrossRefGoogle Scholar
  33. Khan KS, Grufferty A, Gallagher O, Moore DP, Fogarty E, Dowling F. A randomized trial of “soft cast” for distal radius buckle fractures in children. Acta Orthop Belg. 2007;73(5):594–7.PubMedGoogle Scholar
  34. Khosla S, Melton 3rd LJ, Dekutoski MB, Achenbach SJ, Oberg AL, Riggs BL. Incidence of childhood distal forearm fractures over 30 years: a population-based study. JAMA. 2003;290(11):1479–85.PubMedCrossRefGoogle Scholar
  35. Maeda H, Yoshida K, Doi R, Omori O. Combined Monteggia and Galeazzi fractures in a child: a case report and review of the literature. J Orthop Trauma. 2003;17(2)):128–31.PubMedCrossRefGoogle Scholar
  36. Mathison DJ, Agrawal D. An update on the epidemiology of pediatric fractures. Pediatr Emerg Care. 2010;26(8):594–603; quiz 604–6.PubMedCrossRefGoogle Scholar
  37. McLauchlan GJ, Cowan B, Annan IH, Robb JE. Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial. J Bone Joint Surg Br. 2002;84(3):413–17.PubMedCrossRefGoogle Scholar
  38. McQuinn AG, Jaarsma RL. Risk factors for redisplacement of pediatric distal forearm and distal radius fractures. J Pediatr Orthop. 2012;32(7):687–92.PubMedCrossRefGoogle Scholar
  39. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop. 2005;25(4):490–4.PubMedCrossRefGoogle Scholar
  40. Mounts J, Clingenpeel J, McGuire E, Byers E, Kireeva Y. Most frequently missed fractures in the emergency department. Clin Pediatr (Phila). 2011;50(3):183–6.CrossRefGoogle Scholar
  41. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–25.PubMedCentralPubMedCrossRefGoogle Scholar
  42. Niver GE, Ilyas AM. Carpal tunnel syndrome after distal radius fracture. Orthop Clin North Am. 2012;43:521–7.PubMedCrossRefGoogle Scholar
  43. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146–56.PubMedGoogle Scholar
  44. Oakley EA, Ooi KS, Barnett PL. A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm. Pediatr Emerg Care. 2008;24(2):65–70.PubMedCrossRefGoogle Scholar
  45. Ortega Vadillo MA, Robles Valle A, Bermudez Martinez D. Usefulness of the cast index and padding index for the prognosis of pediatric forearm fractures. Acta Ortop Mex. 2010;24(3):146–50.PubMedGoogle Scholar
  46. Pershad J, Monroe K, King W, Bartle S, Hardin E, Zinkan L. Can clinical parameters predict fractures in acute pediatric wrist injuries? Acad Emerg Med. 2000;7(10):1152–5.PubMedCrossRefGoogle Scholar
  47. Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006;117(3):691–7.PubMedCrossRefGoogle Scholar
  48. Pretell-Mazzini J, Carrigan RB. Simultaneous distal radial fractures and carpal bones injuries in children: a review article. J Pediatr Orthop B. 2011;20(5):330–3.PubMedCrossRefGoogle Scholar
  49. Randsborg PH, Gulbrandsen P, Saltyte Benth J, Sivertsen EA, Hammer OL, Fuglesang HF, et al. Fractures in children: epidemiology and activity-specific fracture rates. J Bone Joint Surg Am. 2013;95(7):e42.PubMedCrossRefGoogle Scholar
  50. Ring D, Waters PM, Hotchkiss RN, Kasser JR. Pediatric floating elbow. J Pediatr Orthop. 2001;21(4):456–9.PubMedGoogle Scholar
  51. Ryan LM, Teach SJ, Searcy K, Singer SA, Wood R, Wright JL, et al. Epidemiology of pediatric forearm fractures in Washington, DC. J Trauma. 2010;69 Suppl 4:S200–5.PubMedCrossRefGoogle Scholar
  52. Sanders W, Heckman J. Traumatic plastic deformation of the radius and ulna. Clin Orthop. 1984;188:58–67.PubMedGoogle Scholar
  53. Schmuck T, Altermatt S, Büchler P, Klima-Lange D, Krieg A, Lutz N, et al. Greenstick fractures of the middle third of the forearm. A prospective multi-centre study. Eur J Pediatr Surg. 2010;20(5):316–20.PubMedCrossRefGoogle Scholar
  54. Sen RK, Tripathy SK, Kumar S, Aggarwal S, Tamuk T. Ipsilateral proximal and distal forearm fracture/fracture dislocation in children. J Pediatr Orthop B. 2011;20(3):129–37.PubMedCrossRefGoogle Scholar
  55. Slongo T, Audige L, Schlickewei W, Clavert JM, Hunter J, International Association for Pediatric Traumatology. Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology. J Pediatr Orthop. 2006;26(1):43–9.PubMedCrossRefGoogle Scholar
  56. Smida M, Nigrou K, Soohun T, Sallem R, Jalel C, Ben GM. Combined fracture of the distal radius and scaphoid in children. Report of 2 cases. Acta Orthop Belg. 2003;69(1):79–81.PubMedGoogle Scholar
  57. Symons S, Rowsell M, Bhowal B, Dias JJ. Hospital versus home management of children with buckle fractures of the distal radius. A prospective, randomised trial. J Bone Joint Surg Br. 2001;83(4):556–60.PubMedCrossRefGoogle Scholar
  58. Tabak AY, Celebi L, Muratli HH, Yagmurlu MF, Aktekin CN, Bicimoglu A. Closed reduction and percutaneous fixation of supracondylar fracture of the humerus and ipsilateral fracture of the forearm in children. J Bone Joint Surg Br. 2003;85(8):1169–72.PubMedCrossRefGoogle Scholar
  59. Thompson JC. Netter’s Concise Orthopaedic Anatomy. 2nd ed. Philadelphia: Saunders; 2010.Google Scholar
  60. Vernooij CM, Vreeburg ME, Segers MJ, Hammacher ER. Treatment of torus fractures in the forearm in children using bandage therapy. J Trauma Acute Care Surg. 2012;72(4):1093–7.PubMedGoogle Scholar
  61. von Keyserlingk C, Boutis K, Willan AR, Hopkins RB, Goeree R. Cost-effectiveness analysis of cast versus splint in children with acceptably angulated wrist fractures. Int J Technol Assess Health Care. 2011;27(2):101–7.CrossRefGoogle Scholar
  62. Vorlat P, De Boeck H. Traumatic bowing of children’s forearm bones: an unreported association with fracture of the distal metaphysis. J Trauma. 2001;51(5):1000–3.PubMedCrossRefGoogle Scholar
  63. Ward WT, Rihn JA. The impact of trauma in an urban pediatric orthopaedic practice. J Bone Joint Surg Am. 2006;88(12):2759–64.PubMedCrossRefGoogle Scholar
  64. Waters PM, Bae DS. Fractures of the distal radius and ulna. In: Beaty JH, Kasser JR, editors. Rockwood and Wilkin’s fractures in children. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 292.Google Scholar
  65. Waters PM, Kolettis GJ, Schwend R. Acute median neuropathy following physeal fractures of the distal radius. J Pediatr Orthop. 1994;14(2):173–7.PubMedCrossRefGoogle Scholar
  66. Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am. 2006;88(1):9–17.PubMedCrossRefGoogle Scholar
  67. Welling RD, Jacobson JA, Jamadar DA, Chong S, Caoili EM, Jebson PJ. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol. 2008;190(1):10–6.PubMedCrossRefGoogle Scholar
  68. West S, Andrews J, Bebbington A, Ennis O, Alderman P. Buckle fractures of the distal radius are safely treated in a soft bandage: a randomized prospective trial of bandage versus plaster cast. J Pediatr Orthop. 2005;25(3):322–5.PubMedCrossRefGoogle Scholar
  69. Witney-Lagen C, Smith C, Walsh G. Soft cast versus rigid cast for treatment of distal radius buckle fractures in children. Injury. 2013;44(4):508–13.PubMedCrossRefGoogle Scholar
  70. Young NL, Yoshida KK, Williams JI, Bombardier C, Wright JG. The role of children in reporting their physical disability. Arch Phys Med Rehabil. 1995;76:913–18.PubMedCrossRefGoogle Scholar
  71. 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):841–3.PubMedCrossRefGoogle Scholar
  72. Zimmermann R, Rudisch A, Fritz D, Gschwentner M, Arora R. MR imaging for the evaluation of accompanying injuries in cases of distal forearm fractures in children and adolescents. Handchir Mikrochir Plast Chir. 2007;39(1):60–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Pediatric Orthopedic SurgeryChildren’s Hospital of MichiganDetroitUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Kennedy Krieger InstituteOrthopedic Surgery, Johns Hopkins HospitalBaltimoreUSA

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