Follow-up radiographs are undertaken to identify fractures that become displaced and need manipulation with or without Kirschner-wire fixation. Physeal fractures can result in growth disturbances ( Cannata et al. Complete fractures are therefore considered highly unstable. The periosteal hinge has been considered important for the stability of fractures ( Zamzam and Khoshhal 2005). 2002), but one study reported 7% subsequent displacement among buckle fractures ( Schranz and Fagg 1992). Many authors consider buckle fractures to be stable ( Farbman et al. In addition, the plasticity of the children's long bones can cause a bowing of the radius. This accounts for the range of different fracture types that is uniquely seen in childhood: the buckle (torus), the classical greenstick fracture, the complete fractures (adult type), and the fractures involving the growth plate. The bone is softer and more pliable than in adults. In childhood, the periosteal sleeve is thick and protects the cortex. The great remodeling potential in a child's distal radius allows dorsal angulation of up to 20° for good clinical and anatomical long-term results ( Friberg 1979, Qairul et al. Despite this, clinical and radiographic follow-up examinations are frequently performed ( Green et al. The rate of long-term complications in childhood distal radius fractures is low. Displaced fractures are often manipulated before immobilization. Most minimally displaced fractures are treated without manipulation, and immobilized between 3 and 6 weeks. A precise classification of fracture type at the time of diagnosis would identify a smaller subset of patients that require follow-up.ĭistal radius fractures are the most common fracture in childhood ( Landin 1997), and the incidence is rising ( Hagino et al. Complete fractures of the distal radius are uncommon in children, and highly unstable. Greenstick fractures are unstable and continue to displace after 2 weeks. On average, the complete fractures displaced 9°.Ĭonclusion Buckle fractures are stable and do not require follow-up. The greenstick fractures displaced 5° on average, and continued to displace after the first 2 weeks. The lateral angulation of the buckle fractures did not change importantly throughout the treatment. The greenstick fractures had more complications than the buckle fractures. Results Only 1 of 311 follow-ups led to an active intervention. The fracture type was determined from the initial radiographs and the angulation on the lateral films was noted. Patients and methods The medical records of 305 distal radius fractures in patients aged less than 16 years treated at our institution in 2006 were reviewed, and any complications were noted. The stability of greenstick and buckle fractures of the distal radius was assessed by comparing the lateral angulation radiographically. We investigated the degree to which the follow-up visits reveal complications and lead to change in management. Background and purpose Numerous follow-up visits for wrist fractures in children are performed without therapeutic consequences.
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