Isolated distal radial fractures in children aged 6 to 15years: incidence of redisplacement after casting as seen in Kenyatta national hospital

Abstract

Aim The main aim of the study was to evaluate the incidence of redisplacement of distal radial fractures in children aged between 6 and 15 years and factors contributing to it at the Kenyatta National Hospital. Methodology 'If This was a prospective study carried over eight months from the 22nd June 2005 to 28th February 2006.0ne hundred patients were recruited. The fracture was reduced by the plaster technicians, the usual personnel who reduce these fractures at casualty; reduction was acceptable if the dorsal or volar angulation was less than 20°. The patients were then followed up in the fracture clinic in the next two weeks with another x-ray. It was determined at this point whether there was presence of healing or redisplacement. Redisplacement was regarded as the presence of dorsal volar angulation of greater than 20° or translation greater than 50%. The end point of the study was at week four, x-ray of the distal forearm either showed evidence of redisplacement or evidence of healing at week four in other remaining patients. The data was collected and entered into statistical package for social sciences (SPSS) 12.0 version. It was analyzed using odds ratio, Fisher's exact test and Chi-square test where appropriate. The difference within the variables was taken to be significance if the p value was less than 0.05. Results One patient had fracture of both distal radial bones making the total number of fractures to be 101. Thirty-seven of which were female and thirty four sustained their fractures as a result of involvement in games. Ninety two fractures involved the metaphysis and nine were in the distal third of the radial diaphysis, sixty five were complete fractures while thirty two were torus and only four were greenstick fractures. Fifty nine were angulated (fifty eight dorsal and one volar) and forty two were non-angulated. There were fifty nine displacements, (fifty six dorsal, one volar and two bayonet apposition) and forty two nondisplaced fractures. There were fifty one fractures with no translation of one fragment on the other, thirty five fractures having less than 50% translation and fifteen having greater than 50% translation. Fifty four fractures were judged to be as a result of bending forces and fifteen as a result of shear forces and thirty two as a result of compression forces. Ninety nine patients got below elbow cast while only one had above elbow. Twenty two patients were given analgesics/sedation at reduction while seventy eight had the reduction under no analgesia! sedation. At week two nine (seven patients did not turn up and two did not have check x- rays) patients were not accounted for; and at week four another nine patients (five did not turn up and four did not have check X rays) were not accounted for. At week two, thirteen fractures redisplaced and were remanipulated, and at week four two of the thirteen remanipulated at week two maintained their reduction but four other fractures which had not redisplaced at week two redisplaced making them fifteen all of whom were admitted for operative reduction. In consideration of the whole population seen with isolated distal radial fractures, the incidence of redisplacement would be 14.1% at week two and 18.1 % at week four, but considered as a percentage to the complete and greenstick (which are the fractures at risk of red isplacement) it would be 20.3% at week two and 21.9% at week four. The determinants of redisplacement were; angulation with a p value of 0.021, translation with a p value of 0.009 , completeness of fracture with a p value of 0.004, displacement with a p value of 0.006 and imperfect reduction with p value of 0.003 . Conclusion The incidence of redisplacement of isolated distal fracture in children 6-15 years as seen in this study is comparable to international figures. The factors contributing to redisplacement are completeness of the fracture, initial displacement, translation and imperfect reduction. These factors constitute risk factors to redisplacement of the complete fractures.