Redisplacement Rates after Reduction and Cast Immobilization of Isolated Distal Radial Fractures

Background The maintenance of satisfactory alignment in distal radial fractures following closed reduction and casting of the forearm is challenging. Redisplacement rates of between 2 and 91% have been described, mostly for Western populations and for fractures involving both the forearm bones. The local scenario is unexplored. This study sought to determine the rate of redisplacement in isolated closed distal radial fractures in children aged 6-15 years and the factors contributing to the redisplacement. 2005 and February2006. Patients were recruited from casualty, where the fracture was reduced and casted. Immediate check x-rays were taken to ascertain satisfactory alignment. At follow up the fractures were evaluated for redisplacement in the fracture clinic in the second and fourth weeks with further check x-rays. Redisplacement was regarded as the presence of dorsal or volar- angulation of greater than 20 0 . The data was collected and entered into statistical package for social sciences (SPSS) 12.0 version. Comparison of the binomial outcomes of the factors determining the redisplacement of the distal radial fractures was carried out using Fischer’s exact test. P value <0.05 was taken to be significant. Ninety-two patients were evaluated. Overall redisplacement rate was 15.7%. Factors significantly associated with redisplacement included initial displacement, completeness of fracture and non-satisfactory initial reduction. The rate of redisplacement of 15.7% reported here is within the range that is considered acceptable. The success of re-manipulation at the KNH is unsatisfactory. Percutaneous K-wiring should be considered for those with complete fractures with displacement that do not achieve perfect reduction at initial check radiographic film.


Background
The maintenance of satisfactory alignment in distal radial fractures following closed reduction and casting of the forearm is challenging. Redisplacement rates of between 2 and 91% have been described, mostly for Western populations and for fractures involving both the forearm bones. The local scenario is unexplored. Objective This study sought to determine the rate of redisplacement in isolated closed distal radial fractures in children aged 6-15 years and the factors contributing to the redisplacement.

Setting
The Kenyatta National Hospital, a teaching and referral hospital in Kenya.

Patients and Methods
This was a prospective study carried out between June 2005 and February2006. Patients were recruited from casualty, where the fracture was reduced and casted. Immediate check x-rays were taken to ascertain satisfactory alignment. At follow up the fractures were evaluated for redisplacement in the fracture clinic in the second and fourth weeks with further check x-rays. Redisplacement was regarded as the presence of dorsal or volar-angulation of greater than 20 0 . The data was collected and entered into statistical package for social sciences (SPSS) 12.0 version. Comparison of the binomial outcomes of the factors determining the redisplacement of the distal radial fractures was carried out using Fischer's exact test. P value <0.05 was taken to be significant.

Results
Ninety-two patients were evaluated. Overall redisplacement rate was 15.7%. Factors significantly associated with redisplacement included initial displacement, completeness of fracture and non-satisfactory initial reduction.

Conclusion
The rate of redisplacement of 15.7% reported here is within the range that is considered acceptable. The success of re-manipulation at the KNH is unsatisfactory. Percutaneous K-wiring should be considered for those with complete fractures with displacement that do not achieve perfect reduction at initial check radiographic film.

Redisplacement Rates after Reduction and Cast Immobilization of Isolated Distal Radial Fractures
Ojuka D., Ating'a J.
nomic status were those earning less than $125, while middle those who earn $125-375 per month) were recorded as well as the characteristics of the fracture such as displacement (angulations, translations, direction of displacement) and completeness from the initial radiographic film. The reductions were performed by plaster technicians under sedation for all the patients, as is the standard procedure at the institution, after which check radiographic films were reviewed to assess for adequacy of reduction. All the casts were short arm casts in the manner described by Charnley (7). Because this was an observational study, the technicians were not particularly trained for any type of reduction or cast other than the ones they do for these types of fractures (i.e. complete casts). The initial check radiograph after reduction was used to assess the adequacy of reduction and those which were not satisfactorily reduced were immediately remanipulated under sedation.
The patients were reviewed the following day to check on swelling or check films if not available on the day of reduction at the fracture clinic. Follow up was done in the second and fourth week for all the patients in the fracture clinic. Those who had fracture redisplacement during reviews at second week were remanipulated under sedation. Those whose fractures showed signs of redisplacement at four weeks were admitted for operative reduction. Redisplacement was regarded as the presence of dorsal or volar angulation of greater than 20 0 .This was estimated using a protractor due to the unavailability of goniometer.

Results
Of the one hundred children recruited into the study,  (Table 1).

Discussion
Although the traditional treatment of distal radial fracture by reduction and immobilization in a cast is associated with good functional results (8,9), loss of reduction in the cast is a well-documented problem (8,9). The quoted rate of redisplacement ranges from 2 to 91 % ( 1,3,8,9,10,11).
In this study, we considered only isolated radial frac- The success rate for our remanipulation seems inferior to those of Gibbon et al (10). A consideration for percutaneous K wiring may be required as the primary treatment where the risk of redisplacement is high.