Displaced distal radius fractures in children are common and often reduced if necessary and immobilized in cast. Still, fracture redisplacement frequently occurs. This can be prevented by fixation of fracture fragments with K-wires, but until now, there are no clear guidelines for treatment with primary K-wire fixation. This meta-analysis aimed to identify risk factors for redisplacement after reduction and cast immobilization of displaced distal radius fractures in children, and thereby determine which children will benefit most of primary additional K-wire fixation. Eight databases were searched to identify studies and extract data on the incidence of and risk factors for redisplacement of distal radius fractures after initial reduction and cast immobilization in children. Twelve studies, including 1256 patients, showed that initial complete displacement (odds ratio [OR] 4.69, 95% confidence interval [CI] 2.98–7.39) and presence of a both-bone fracture (OR 1.95, 95% CI 1.34–2.85) were independent risk factors for redisplacement. Anatomical reduction reduced the redisplacement risk (OR 0.14, 95% CI 0.05–0.40). No significant influence on redisplacement risk could be established for female sex, experience level of the attending surgeon, Cast Index < 0.8, Three-Point Index < 0.8 and patient’s age. For children with a displaced distal radius fracture, the presence of a both-bone fracture, complete displacement of the distal radius and non-anatomical reduction are risk factors for redisplacement after reduction of their initially displaced distal radius fracture. Children with one or more of these risk factors probably benefit most of reduction combined with primary K-wire fixation.

/pdf/risk-factors-for-fracture-redisplacement-after-reduction-and-1t0sulph0s.pdf

Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis

Management of Osteochondritis Dissecans Lesions of the Knee, Elbow and Ankle.

Redisplacement is the most common complication
of immobilisation in a cast for the treatment of diaphyseal fractures
of the forearm in children. We have previously shown that the three-point
index (TPI) can accurately predict redisplacement of fractures of
the distal radius. In this prospective study we applied this index
to assessment of diaphyseal fractures of the forearm in children
and compared it with other cast-related indices that might predict
redisplacement. A total of 76 children were included. Their ages,
initial displacement, quality of reduction, site and level of the
fractures and quality of the casting according to the TPI, Canterbury
index and padding index were analysed. Logistic regression analysis
was used to investigate risk factors for redisplacement. A total
of 18 fractures (24%) redisplaced in the cast. A TPI value of >
0.8 was the only significant risk factor for redisplacement (odds
ratio 238.5 (95% confidence interval 7.063 to 8054.86); p The TPI was far superior to other radiological indices, with
a sensitivity of 84% and a specificity of 97% in successfully predicting
redisplacement. We recommend it for routine use in the management
of these fractures in children. Cite this article: Bone Joint J 2013;95-B:563–7.

The value of the three-point index in predicting redisplacement of diaphyseal fractures of the forearm in children

Background:Osteochondritis dissecans (OCD) of the elbow has almost exclusively been described in the humeral capitellum, with only a small number of reports describing secondary osteochondral chang...

https://journals.sagepub.com/doi/pdf/10.1177/2325967118769059

Radial Head Changes in Osteochondritis Dissecans of the Humeral Capitellum.

This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.

https://journals.sagepub.com/doi/pdf/10.1177/1947603519847735

Osteochondritis Dissecans of Smaller Joints: The Elbow.

The aim of this study was to retrospectively identify the role of plaster in redisplacement of dorsal distal radius fracture in children. A total of 60 children with displaced dorsal distal radius fractures were included in this study. All these fractures were reduced under general anesthesia. A total of 22 redisplacements were observed. Statistical analysis was performed to search for risk factors of redisplacement. Poor modeling immobilization of the wrist in the cast, studied by the three-point index was the only significant risk factors for redisplacement. The three-point index is an excellent index to predict redisplacement and assess the quality of the cast treatment of these fractures. The type of study or level of evidence is therapeutic IV.

Dorsal distal radius fractures in children: role of plaster in redisplacement of these fractures.

Osteochondritis dissecans of the radial head: A case report

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Dorsal distal radius fractures in children: role of plaster in redisplacement of these fractures.

Osteochondritis dissecans of the radial head: A case report