Redisplacement of diaphyseal fractures of the forearm after closed reduction in children: a retrospective analysis of risk factors.

OBJECTIVES: Manipulation and plaster fixation is the primary management for diaphyseal fractures of the radius and/or ulna in children. This study was designed to evaluate risk factors of fracture redisplacement after closed reduction and cast immobilization. DESIGN: Retrospective study. SETTING: Tertiary hospital. PATIENTS: Fifty-seven children with fractures of the radius were included. INTERVENTION: The medical records of patients with/without ulna treated with closed reduction and casting were reviewed. MAIN OUTCOME MEASURES: Data analyzed were age, sex, dominant hand, fracture pattern, reduction quality, experience of the surgeon, and type of anesthesia. Logistic regression was used for multivariate analysis. RESULTS: There were 41 (71.9%) males and 16 (28.1%) females with a mean age of 9.74 ± 3.07 years. There were 53 radius fractures and 54 ulna fractures, and 22 subjects experienced redisplacement. The redisplacement rate of radius fractures was 34% and of ulnar fractures was 27.8%. Multivariate analysis showed that the factors associated with redisplacement of radius fractures were fair reduction quality [odds ratio (OR), 8.45] and complete fracture (OR 9.62) and those for redisplacement of ulna fractures were fair reduction quality (OR 8.10) and complete fracture (OR 8.43). CONCLUSIONS: Poorer reduction and complete fracture are more likely to result in redisplacement, and surgical management may be considered in these cases.