Displaced Distal Radius Fractures in Children: To Reduce or Not to Reduce? To Pin or Not to Pin?

Abstract

Displaced distal radius fractures in children are routinely treated with closed reduction under sedation, which adds risk and cost. Yet some metaphyseal fractures, especially in young children (under age 10), have the capacity to remodel some degrees of displacement without reduction. At any given age, it is not clear which patients and which fractures need reduction, and further which fractures need to be pinned. This review summarizes the available literature and hopes to guide clinicians in the treatment of children with distal radius fractures presenting to their practice. Key Concepts: • Remodeling potential of the metaphyseal distal radius is significant in both the sagittal and coronal planes. • Complete remodeling without sequelae of 100% displaced and shortened distal radius fractures has been reported in children under age 10. • Despite the above, displaced distal radius fractures in children often undergo sedated reduction, and when performed, pinning eliminates loss of reduction but may lead to unnecessary surgery. • Prospective randomized trials that compare in situ stabilization and reduction are needed.