Distal radius fractures

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.