Halim, Syurahbil Abdul
(2019)
Cast versus wire fixation in displaced distal radius fractures in children : outcomes at skeletal maturity.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: Displacement following fracture reduction was a common
complication during casting period in children previously treated for the distal radius
fracture. Fracture stabilization with wire fixation was also used to maintain the
reduction during fracture healing, but not without complications. We evaluated the
clinical and radiological outcomes at skeletal maturity of distal radius fractures in
children previously treated either with cast alone or with wire fixation.
Methodology: A retrospective study of 57 patients with both metaphyseal and
physeal fractures of distal radius was conducted. Out of 30 patients with metaphyseal
fractures, 19 were in cast group and 11 were in wire group. Nineteen out of 27
patients with physeal fractures were from cast group while eight were from wire
group. All were evaluated clinically and radiologically at or after skeletal maturity at
the mean follow up of 6.5 years (3.0 to 9.0 years).
Results: In metaphysis group, patients treated with wire fixation had more restriction
in wrist palmarflexion (p=0.04) only but in physis group, more restriction of motion
was found in both dorsiflexion (p=0.04) and palmarflexion (p=0.01) when compared
to contralateral wrist. In physis group, there was a statistically significant difference
in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation.
No radiological difference was found in metaphysis group. All patients were pain free
except one (5.3%) in physis group who had only a mild pain. Grip strength showed no
statistical difference in all groups. Complications of wire included radial and ulnar
physeal arrests, pin site infection and numbness.
Conclusions: Cast and wire fixation showed excellent and good outcomes at skeletal
maturity in children with previous distal radius fracture involving both metaphysis
and physis. Site of fracture and type of treatment subjected have no influence on the
grip strength at skeletal maturity.
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