Remodeling of distal radius fractures in children: preliminary retrospective cost/analysis in level II pediatric trauma center
Keywords:
distal radius fracture, overriding fracture, conservative treatment, remodeling, cost analysisAbstract
Background and aim: Children displaced distal radius fractures (DRFs) are commonly treated by reduction. Yet, their excellent remodeling ability provides good clinical-radiographic outcomes even in case of non-anatomical reduction. The reduction under analgesia or sedation involves hospitalizations, greater risks, and higher hospital costs. The aim of this preliminary study is to demonstrate the accountability and conveniency of non-anatomical reduction.
Methods: The study involved all 0-8 years-old children who were affected by a closed overriding DRF from February 2017 to December 2018 and were managed non-operatively by a long arm cast without reduction, analgesia, or sedation treatments. We retrospectively evaluated their clinical-radiographic outcomes and healing time. The costs of no-reduction treatments were compared with those of the two main approaches to DRFs, that is: closed reduction under sedation and application of a long arm cast; closed reduction under anesthesia, percutaneous pinning, and application of a long arm cast. The comparison was based on the Diagnosis Related Group system.
Results: We treated 11 children with an average initial radial shortening of 5±3 mm and average initial sagittal and coronal angulations of 4.0° and 3.5°, respectively. Average casting duration was 40 days. All patients achieved a full range of wrist motion without deformities. The procedure was respectively 7 times less expensive than closed reduction in emergency room under sedation and application of a long arm cast, and 64 times less expensive than closed reduction in the operating room under anesthesia, percutaneous pinning, and application of a long arm cast.
Conclusions: In children aged 0-8 years, non-operative treatment of closed overriding DRFs with a long arm cast without reduction is a simple and cost-effective procedure with both clinical and radiographic medium-term excellent outcomes.
References
Do TT, Strub WM, Foad SL, Mehlman CT, Crawford AH. Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis. J Pediatr Orthop B. 2003 Mar;12(2):109-15. doi: 10.1097/01.bpb.0000043725.21564.7b. PMID: 12584495.
Wendling‑Keim D. S., Wieser B., Dietz H.G. Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children? Eur J Trauma Emerg Surg 2015;41:421–428. doi: 10.1007/s00068-014-0483-7
Aitken A.P. Further observations on the fractured distal radial epiphysis. J Bone Joint Surg 1935; 17:922–927.
Wilkins K.E. Principles of fracture remodeling in children. Injury 2005 Feb; 36 Suppl 1: A3-11. doi: 10.1016/j.injury.2004.12.007.
Handoll HH, Elliott J, Iheozor-Ejiofor Z, Hunter J, Karantana A. Interventions for treating wrist fractures in children. Cochrane Database Syst Rev. 2018 Dec 19;12:CD012470. doi: 10.1002/14651858.CD012470.pub2.
DeNoble PH, Marshall AC, Barron OA, Catalano LW 3rd, Glickel SZ. Malpractice in distal radius fracture management: an analysis of closed claims. J Hand Surg Am.2014 Aug;39(8):1480-8. doi: 10.1016/j.jhsa.2014.02.019. Epub 2014 Apr 29.
Pena B, Kraus B. Adverse events of procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med 1999; 34:483–491.
Price C, Scott D, Kurzner M, Flynn J. Malunited forearm fractures in children. J Pediatr Orthop 1990; 10:705–712.
Roy D. Completely displaced distal radius fractures with intact ulnas in children. Orthopedics 1989; 12:1089–1092.
Crawford AH. Pitfalls and complications of fractures of the distal radius and ulna in childhood. Hand Clinics 1988; 4:403–413.
Crawford SN, Lee LS, Izuka BH. Closed treatment of overriding distal radial fractures without reduction in children. J Bone Joint Surg Am. 2012 Feb 1;94(3):246-52. doi: 10.2106/JBJS.K.00163. PMID: 22298057.
Mark A. Seeley MD, Peter D. Fabricant MD, MPH, J. Todd R. Lawrence MD, PhD Teaching the Basics: Development and Validation of a Distal Radius Reduction and Casting Model Clin Orthop Relat Res 2017; 475:2298–2305. doi: 10.1007/s11999-017-5336-3
Marinelli M, Di Giulio A, Mancini M. Validation of the Ottawa Ankle Rules in a II level Trauma Center in Italy. J Orthopaed Traumatol 2007; 8(1): 16-20.
Marinelli M, Soccetti A, Panfoli N, de Palma L. Cost-Effectiveness of Total Hip Arthroplasty. A Markov Decision Analysis based on implants cost. Journal of Orthopedics and Traumatology 2008; 9(1): 23-28.
Ogden JA, Beall JK, Conlogue GJ, Light TR. Radiology of postnatal skeletal development. IV. Distal radius and ulna. Skeletal Radiol. 1981;6:255-66.
Friberg KS. Remodelling after distal forearm fractures in children. III. Correction of residual angulation in fractures of the radius. Acta Orthop Scand. 1979;50(6 Pt 2):741-9.
Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6:146-56.
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
