Displaced distal radius fractures in children, cast alone vs additional K-wire fixation: a meta-analysis

Abstract

Purpose: Displaced distal radius fractures in children are common and often treated by reduction and cast immobilization. Redisplacement occurs frequently and may be prevented by additional treatment with K-wire fixation after initial reduction. This meta-analysis aims to summarize available literature on this topic and determine if primary K-wire fixation is the preferred treatment for displaced distal radius fractures in children.

Methods: A search in eight databases identified studies that compared cast immobilization alone to additional K-wire fixation as treatment for displaced paediatric distal radius fractures. The primary outcome was the redisplacement rate. Secondary outcomes were secondary reduction rate, range of motion and complications. This meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement.

Results: Three RCTs and 3 cohort studies, analysing 197 patients treated with cast immobilization alone and 185 with additional K-wire fixation, were included in this meta-analysis. Redisplacement occurred less frequently after additional K-wire fixation than after cast alone (3.8 versus 45.7%; OR 0.07, 95% CI 0.03-0.15). Secondary reduction was performed in 59.8% of the redisplaced fractures. Complications, other than redisplacement, occurred more often after additional K-wire fixation than after cast alone (15.7 versus 3.6%). Range of motion did not differ after both treatments.

Conclusions: Additional K-wire fixation is a suitable treatment to prevent redisplacement and secondary operations after initial reduction of displaced distal radius fractures in children, but is associated with post-procedural complications. Additional K-wire fixation does not result in a better range of motion than cast immobilization alone. More research is needed to identify those patients who will benefit the most from K-wire fixation as a treatment for displaced distal radius fractures in children.

Keywords: Cast immobilization; Complications; Distal radius; K-wire fixation; Outcome; Paediatric; Range of motion; Redisplacement; Reduction.

Fig. 1

Flowchart of study selection

Fig. 2

Redisplacement rate; additional K-wire fixation vs cast immobilization alone for a all patients with distal radius fractures patients, b patients with metaphyseal fractures, c patients with both-bone distal fractures, d patients with isolated distal radius fractures and e patients with completely displaced distal fractures

Fig. 3

Range of motion in degrees; Mean difference between additional K-wire fixation vs Cast immobilization alone for a flexion, b extension, c pronation, d supination, e radial deviation, f ulnar deviation