- Email: [email protected]
Current Management Patterns of Pediatric Distal Radius Fractures
RESULTS In all cases elongation was undertaken for enhanced function. Therefore a functional follow-up evaluation was performed which demonstrated improved prosthetic wear in individuals where stumps were lengthened for improved mechanical advantage; two point discrimination and dexterity demonstrated enhanced ability to manipulate fine objects, use writing instruments and perform activities of daily living, while maintaining a stable degree of both protective and discriminatory sensation throughout the lengthening process with preservation at the time of final evaluation. Protection of physeal plates in skeletally immature patients has demonstrated persistent growth of the lengthened part while lengthening in the absence of a healthy physeal plate or through previously transplanted bone has generated a need in some cases for secondary lengthening. Family and patient satisfaction rates are extremely high with 95% of patients demonstrating a willingness to undergo this surgery a second time in order to achieve the same functional result. CONCLUSION Although there is a longer duration of time necessary for consolidation of bone than needed with prior techniques of rapid lengthening and bone graft interposition, the current technique of callotasis lengthening has obviated the need for a second operative procedure and has reduced the morbidity associated with this second procedure. The slow lengthening technique utilized has also demonstrated an acceptable level of comfort throughout the lengthening and consolidation period. The application of callus distraction to the hands and upper extremities of children born with congenital deformities and following severe traumatic tissue loss, through the development of “user friendly” apparatus and surgical techniques have afforded substantial life enhancing outcomes. M
Full- or part-time employment or consulting arrangement with Stryker
PAPER 46 ∙
Saturday, October 9, 2010 8:54-9:00 AM Paper Session 5: Nerve and Congenital
Current Management Patterns of Pediatric Distal Radius Fractures Not a clinical study v Joshua G. Bales, MD
Scott Mitchell, MD Nicholas Bernthal, MD Mauricio Silva, MD Prosper Benhaim, MD BACKGROUND Distal radius fractures are common in the pediatric population. Although parameters of satisfactory alignment for these fractures are often cited in orthopaedic texts, standardized treatment protocols have not been well defined. We sought to examine the diversity of current practice patterns in the treatment of these fractures by surveying hand, pediatric and general orthopaedic surgeons. v Speaker has nothing of financial value to disclose
HYPOTHESIS Significant variation exists in the management of pediatric distal radius fractures. METHODS Hand, pediatric orthopaedic, and general orthopaedic surgeons were surveyed using an internet-based questionnaire regarding management of pediatric distal radius fractures. Ten cases were included in the survey to represent a broad spectrum of injuries, from minimally angulated torus fractures to completely displaced fractures with bayonet apposition. Patients in the survey varied in age at the time of injury from 3 to 15 years of age. For each case, surgeons were asked to select a preferred treatment based first on injury films and then again after reviewing approximately one-week follow-up radiographs. RESULTS A total of 781 surgeons completed the survey. Compared to pediatric orthopaedic surgeons, hand surgeons were 2.9 times as likely to recommend surgery and general orthopaedic surgeons were 1.6 times as likely to recommend surgery (p-values of 0.014 and 0.001 respectively) after viewing the initial radiograph. Private practice surgeons were 1.5 times as likely to recommend surgery compared to academic surgeons based on the initial injury radiograph. Collectively, respondents were 2.1 times as likely to recommend surgery after viewing the second set of radiographs one-week post injury. Despite the high incidence of these fractures, most surgeons who treat pediatric distal radius fractures report that pediatric patients constitute less than 10% of their practice. Of note, all of the patients included in our survey were successfully managed nonoperatively (individual cases from the survey can be presented for audience review). SUMMARY POINTS ∙ Our survey highlights substantial disparity in management of pediatric distal radius fractures and the need for more standardized treatment of these fractures. ∙ Further study is warranted to determine if these variations in treatment will ultimately affect patient outcomes. REFERENCES 1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg 2004;29A: 458-461. 2. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg 2008; 33A: 1911-1923. 3. Waters PM, Mih AD in Rockwood and Wilkin’s Fractures in Children. 6th Edition, Lippincott Williams & Wilkins, 2006 pgs. 337-398. 4. Blount WP, Schaefer AA, Johnson JH. Fractures of the forearm in children. JAMA 1942;120:111-116. 5. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146-156. 6. Helenius I, Lamberg TS, Kaariainen S, Impinen A, Pakarinen. Operative treatment of fractures in children is increasing. A population-based study from Finland. J Bone Joint Surg 2009;91:2612-2616.
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Full- or part-time employment or consulting arrangement with Stryker
PAPER 46 ∙
Saturday, October 9, 2010 8:54-9:00 AM Paper Session 5: Nerve and Congenital
Current Management Patterns of Pediatric Distal Radius Fractures Not a clinical study v Joshua G. Bales, MD
Scott Mitchell, MD Nicholas Bernthal, MD Mauricio Silva, MD Prosper Benhaim, MD BACKGROUND Distal radius fractures are common in the pediatric population. Although parameters of satisfactory alignment for these fractures are often cited in orthopaedic texts, standardized treatment protocols have not been well defined. We sought to examine the diversity of current practice patterns in the treatment of these fractures by surveying hand, pediatric and general orthopaedic surgeons. v Speaker has nothing of financial value to disclose
HYPOTHESIS Significant variation exists in the management of pediatric distal radius fractures. METHODS Hand, pediatric orthopaedic, and general orthopaedic surgeons were surveyed using an internet-based questionnaire regarding management of pediatric distal radius fractures. Ten cases were included in the survey to represent a broad spectrum of injuries, from minimally angulated torus fractures to completely displaced fractures with bayonet apposition. Patients in the survey varied in age at the time of injury from 3 to 15 years of age. For each case, surgeons were asked to select a preferred treatment based first on injury films and then again after reviewing approximately one-week follow-up radiographs. RESULTS A total of 781 surgeons completed the survey. Compared to pediatric orthopaedic surgeons, hand surgeons were 2.9 times as likely to recommend surgery and general orthopaedic surgeons were 1.6 times as likely to recommend surgery (p-values of 0.014 and 0.001 respectively) after viewing the initial radiograph. Private practice surgeons were 1.5 times as likely to recommend surgery compared to academic surgeons based on the initial injury radiograph. Collectively, respondents were 2.1 times as likely to recommend surgery after viewing the second set of radiographs one-week post injury. Despite the high incidence of these fractures, most surgeons who treat pediatric distal radius fractures report that pediatric patients constitute less than 10% of their practice. Of note, all of the patients included in our survey were successfully managed nonoperatively (individual cases from the survey can be presented for audience review). SUMMARY POINTS ∙ Our survey highlights substantial disparity in management of pediatric distal radius fractures and the need for more standardized treatment of these fractures. ∙ Further study is warranted to determine if these variations in treatment will ultimately affect patient outcomes. REFERENCES 1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg 2004;29A: 458-461. 2. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg 2008; 33A: 1911-1923. 3. Waters PM, Mih AD in Rockwood and Wilkin’s Fractures in Children. 6th Edition, Lippincott Williams & Wilkins, 2006 pgs. 337-398. 4. Blount WP, Schaefer AA, Johnson JH. Fractures of the forearm in children. JAMA 1942;120:111-116. 5. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146-156. 6. Helenius I, Lamberg TS, Kaariainen S, Impinen A, Pakarinen. Operative treatment of fractures in children is increasing. A population-based study from Finland. J Bone Joint Surg 2009;91:2612-2616.
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