This prospective study evaluates seventy-five displaced or severely angulated distal radius fractures in seventy-four children under the age of fifteen years. All patients underwent a closed manipulation under conscious sedation in the Emergency Room with placement of a short arm cast. Overall, the greatest risk factors for displacement were initial complete fracture displacement and the degree of obliquity of the fracture. Fractures that were completely displaced were 12 times more likely to redisplace than were angulated but incompletely displaced fractures. Fractures with 10°, 20°, and 30°, of obliquity were, respectively, 2, 5, and 11 times more likely to redisplace than was a true transverse fracture. The three-point index was superior to other radiographic indices for predicting redisplacement with a sensitivity and sensitivity of 95%, a negative predictive value of 98% and a positive predictive value of 86%. Fracture of the ulna did not increase the rate of redisplacement.
This study provides valuable information for the treatment of distal radius fractures in children. Considering that most of these fractures are treated with closed manipulation in the Emergency Room with close follow up, those patients with 100% displacement and a high degree of obliquity at the fracture site may be best treated with supplemental pin fixation.