Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc s
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ORIGINAL ARTICLE
Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc system and K‑wire pinning Marco Passiatore1 · Rocco De Vitis2 · Andrea Perna1 · Marco D’Orio1 · Vitale Cilli3 · Giuseppe Taccardo2 Received: 1 April 2020 / Accepted: 7 May 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Introduction Closed reduction and internal fixation are a widespread surgical treatment for pediatrics displaced extraphyseal distal radius fractures. Post-surgical cast immobilization is usually needed. Epibloc system (ES) is a device used to fix Colles fractures in adults, not requiring post-surgical immobilization. The aim of the study is to investigate the effectiveness of ES in a pediatric population suffering from displaced extraphyseal distal radius fractures. Methods We retrospectively analyzed 52 patients (age 8–12 years) who underwent CRIF. Patients were divided into two groups. Group A (25 patients): ES osteosynthesis. Group B (27 patients): K-wires and short arm cast osteosynthesis. The primary outcome is the maintenance of reduction in radiographs (displacement on frontal and lateral view). The secondary outcome is the reaching of the complete active range of motion recovery (compared with the contralateral side) and the time needed to obtain it. The need of further additional treatment (physiotherapy) and the presence of complication were also assessed. Results Reduction was equally maintained in both groups (p > 0.05). Physiotherapy was mandatory for 11 patients in group B; only for 3 patients in group A, the difference was statistically significant (p = 0.03) according to Fisher test. Otherwise, the difference was not statistically significant regarding complications. (p > 0.05). At the last follow-up, complete functional recovery was reached in all patients. Conclusions Functional recovery is faster, and postoperative physiotherapy is rarely required with ES. This device allows us to go beyond the traditional concept of mandatory postoperative immobilization after pediatric wrist fractures surgery. Keywords Wrist fracture · Pediatric · CRIF · Forearm · Cast immobilization
Introduction The distal radius represents one of the most common sites of pediatric fracture, amounting about the 25% of all fractures [1]. Stable and extra-articular distal radius fractures could be treated successfully in a conservative way with * Marco Passiatore [email protected] 1
Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati 31, 00168 Roma, Italia
2
Istituto Di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italia
3
Chirurgie de La Main, CHIREC Site Delta, Bruxelles, Belgium
close reduction and cast immobilization [2]; however, surgery plays an important role in the unstable and displaced fractures [3, 4]. The aims of surgery are to restore the correct length of the bone, to fix the fractur
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