Redisplacement Rates after Reduction and Cast Immobilization of Isolated Distal Radial Fractures

Abstract

Background: The maintenance of satisfactory alignment in distal radial fractures following closed reduction and casting of the forearm is challenging. Redisplacement rates of between 2 and 91% have been described, mostly for Western populations and for fractures involving both the forearm bones. The local scenario is unexplored. Objective: This study sought to determine the rate of redisplacement in isolated closed distal radial fractures in children aged 6-15 years and the factors contributing to the redisplacement. Setting: The Kenyatta National Hospital, a teaching and referral hospital in Kenya. Patients and Methods: This was a prospective study carried out between June 2005 and February 2006. Patients were recruited from casualty, where the fracture was reduced and casted. Immediate check x-rays were taken to ascertain satisfactory alignment. At follow up the fractures were evaluated for redisplacement in the fracture clinic in the second and fourth weeks with further check x-rays. Redisplacement was regarded as the presence of dorsal or volar- angulation of greater than 200. The data was collected and entered into statistical package for social sciences (SPSS) 12.0 version. Comparison of the binomial outcomes of the factors determining the redisplacement of the distal radial fractures was carried out using Fischer’s exact test. P value <0.05 was taken to be significant. Results: Ninety-two patients were evaluated. Overall redisplacement rate was 15.7%. Factors significantly associated with redisplacement included initial displacement, completeness of fracture and non-satisfactory initial reduction. Conclusion: The rate of redisplacement of 15.7% reported here is within the range that is considered acceptable. The success of re-manipulation at the KNH is unsatisfactory. Percutaneous K-wiring should be considered for those with complete fractures with displacement that do not achieve perfect reduction at initial check radiographic film.