Prevention of secondary displacement and reoperation of distal metaphyseal forearm fractures in children

Clinical Follow-Up without Radiographs Is Sufficient after Most Nonoperatively Treated Distal Radius Fractures in Children

Distal forearm fractures are common in children and are usually treated nonoperatively. No consensus has been reached on how to perform clinical and radiographic follow-up of these fractures. Our aim was to study whether radiographic and clinical follow-up is justified. We included 100 consecutive patients with non-operatively treated distal forearm fractures who were treated at Oulu University Hospital in 2010-2011. The natural history of the fractures during the nonoperative treatment was analyzed by measuring the potential worsening of the alignment during the follow-up period. The limits of acceptable fracture position were set according to the current literature using "strict" or "wide" criteria for alignment. We determined the rate of worsening fracture position (i.e., patients who reached the threshold of unacceptable alignment). In relation to splinting, we evaluated how many patients benefited from clinical follow-up. Most of the fractures (98%) preserved acceptable alignment during the entire follow-up period when wide criteria were used. The application of stricter criteria for alignment in radiographs showed loss of reduction in 19% of the fractures. Worsening of the alignment was recognized at a mean of 13 days (range 5-29) after the injury. One in three (32%) patients needed some intervention due to splint loosening or failure. Radiographic follow-up of nonoperatively treated distal forearm fractures remains questionable. Instead, clinical follow-up is important, as 32% of patients needed their splints fixed.

The Golden Ratio in Pediatric Wrist Anatomy: A Divine Symmetry

Introduction: The golden ratio, which equals 1.61803…, and is usually defined by the Greek letter φ (phi), has attracted broad attention for a long time. It has been found in many phenomena in the universe including, body symmetry and locomotion. Within this context, the purpose of our study was to evaluate normal morphometric measurements of the wrist in the pediatric population and to identify if phi (φ) is part of the distal radioulnar joint. 

Methods: We retrospectively reviewed the hospital records of all skeletally immature patients requiring surgical intervention for distal radius fracture in our unit between January 2010 and January 2017. We define and describe a reproducible method to measure the ratio of the distal radial and ulnar physes.

Results: A total of 268 patients were included with a mean age of 9.41 (3-16) years and a mode of 7 years. Some 63.4% were boys -- 43.3% were right-sided injuries and 56.7% were left-sided injuries. The ratio between the total width of the radial and ulnar growth plates and the radial growth plate closely approximated φ; the mean of this ratio in all the patients included was 1.619684 (1.5848-1.6643). Most of the injuries happened in the summertime, between May and August.

Conclusion: We found that the golden ratio exists in our body to play its harmony in the pediatric wrist joint. We believe that with the support of further studies, the golden ratio might yield diagnostic and prognostic implications in the treatment of distal radius/ulnar fractures or abnormalities in this population.