Diametaphyseal Distal Forearm Fractures in Children: A STROBE Compliant Comparison of Outcomes of Different Stabilization Techniques Regarding Complications

Abstract

Diametaphyseal forearm fractures are difficult to treat because standard methods for long-bone fracture stabilization in the metaphyseal or diaphyseal regions are less effective in this transition zone. We hypothesized that there is no difference in outcomes between conservative and surgical treatment of diametaphyseal forearm fractures. This retrospective analysis included 132 patients who had undergone treatment for diametaphyseal forearm fracture between 2013 and 2020 at our institution. The primary analysis compared complications occurring in patients treated conservatively with those occurring in patients managed surgically (ESIN, K-wire fixation, KESIN stabilization, or open reduction and plate osteosynthesis). In a subgroup analysis, we compared the two most frequently applied surgical stabilization techniques in distal forearm fractures (i.e., ESIN and K-wire) with conservative treatment. The mean age of the patients at the time of intervention was 9.43 ± 3.78 years (mean ± SD). Most patients were male (91; 68.9%), and 70 of 132 (53.1%) patients underwent surgical stabilization. The rate of re-intervention or complications was similar after conservative and surgical treatment, and ESIN or K-wire fixation achieved comparable complication rates. Recurrent displacement of fragments was the most frequent reason for re-interventions (13 of 15 patients; 86.6%). There was no permanent damage as a result of a complication. The median time of exposure to image intensifier radiation was comparable between ESIN (95.5 s) and K-wire fixation (85.0 s), but significantly lower during conservative treatment (15.0 s; p = 0.001).

Keywords: ESIN; K-wire; diametaphyseal fracture; distal radius; pediatric trauma.

Figure 1

Definition of the diametaphyseal transition zone.

Figure 2

Flow chart of patient enrollment.

Figure 3

Change of axis deviation in lateral plane X-ray images obtained immediately after surgery, compared to axis deviations observed at the last follow-up, by age at surgery and the three types of stabilization.

Figure 4

Total time of exposure to image intensifier radiation relative to the type of treatment (n = 127). Conservative treatment was applied in 62 patients, ESIN/K-ESIN in 18 (14/4) patients, and K-wire fixation in 47 patients.

Figure 5

The boxplot graph shows that ESIN was significantly more often used in proximal fractures and K-wires more often in fractures located more distally within the diametaphysis of the distal radius.

Figure 6

Boy, aged 9.5 years. He fell from a height of 1 m. (a) The image shows a completely displaced diametaphyseal fracture of the radius and a greenstick fracture of the distal shaft of the ulna. (b) Intraoperative image intensifier images during K-wire fixation of the diametaphyseal fracture of the radius. Note that a K-wire takes an intramedullary course within the proximal fragment, thereby reducing the stability of the fixation. (c) X-ray images obtained after 3 weeks show incomplete consolidation of fractures. K-wires were removed subsequently, and a forearm splint was applied. (d) X-ray images obtained after 7 weeks show a delayed fracture union and recurrent dorsal displacement of the radius fracture. (e) Open reduction and plate fixation were carried out 8 weeks after the injury. (f) Five months after the injury and 3 months after plate fixation, the fracture had healed.