Dorsal cortical comminution as a predictor of redisplacement of distal radius fractures in children

Background: The purpose of this study was to evaluate the various factors, which could contribute towards redisplacement of distal radius fractures, including comminution of the dorsal cortex of the distal radius, treated in our department. Methods: In this retrospective study, we evaluated the risk of redisplacement of distal radius fractures in our department and also looked at the probable factors predisposing to this risk. A total of 134 fractures (129 children) were included in the study after exclusions. The variables that were assessed as possible causes of redisplacement were age, gender, fracture pattern (apex), degree of initial displacement, presence/absence of comminution, presence/absence of ulnar fracture, grade of surgeon, quality of initial reduction and Cast index. Results: After excluding the fractures without a known outcome, 124 fractures (120 children) were available for analysis. The average age of children was 10.6 years (range 2-16 years) with more boys (89) than girls (31). Redisplacement after an initial reduction occurred in 30 children (24%). Six of these children (4.8% of the entire study group) required further intervention. The factors associated with an increased risk of redisplacement were complete initial displacement of fracture (p = 0.02), dorsal bayonet fracture pattern (p = 0.007), presence of comminution (p = 0.001) and the quality of the initial reduction (p = 0.002). Forward stepwise logistic regression analysis revealed comminution at the fracture site to be the most significant factor associated with redisplacement, increasing the odds of redisplacement by 5.82 (95% confidence interval (CI): 2.08-16.22, p = 0.001). There seemed to be a trend towards a reduced risk of redisplacement when K-wiring was done in the presence of comminution (p = 0.12). Conclusion: The presence of dorsal cortical comminution at the fracture site on initial radiographs should alert the treating surgeon to a significantly higher risk of redisplacement and supplemental K-wiring should be considered in this situation. (C) 2010 Elsevier Ltd. All rights reserved.