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Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis

Do, Twee T.; Strub, William M.; Foad, Susan L.; Mehlman, Charles T.; Crawford, Alvin H.

Journal of Pediatric Orthopaedics B: 2003 - Volume 12 - Issue 2 - p 109-115
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The inherent ability of pediatric metaphyseal radius fractures to heal and remodel made us question the need for immediate anatomic reduction under conscious sedation. We believe that isolated closed distal radius fractures with 15° of angulation and 1 cm of shortening will heal well and remodel completely without clinical or functional sequelae. Time and expense can be decreased by splinting and follow-up without the need for immediate anatomic reduction in the emergency room. In order to answer this question, we retrospectively evaluated 34 pediatric metaphyseal wrist fractures that lost position after attempted reduction and healed in their angulated or shortened position. We looked at the time to healing, time to remodeling and any residual clinical or functional deficits. We then did a comparison cost analysis with time matched patients who had complete but minimally displaced fractures of the distal radius that were treated by immediate splinting with orthopaedic follow-up. Our results showed that skeletally immature patients with open physes, isolated injuries, dorsovolar and radioulnar angulations less than 15° and less than 1 cm of shortening will heal and be out of cast within an average of 6 weeks and completely remodel within an average of 7.5 months. The average time in the emergency room was 2 h less with no reduction. The cost of the emergency room visit with attempted reduction was 50% more than splinting with early referral (US$536 versus US$270). None of our patients had significant clinical deformities or residual functional deficits.

Department of Pediatric Orthopaedics, Children's Hospital Medical Center, Cincinnati, Ohio, USA

Correspondence and requests for reprints to Twee Do, MD, 3333 Burnet Ave., Cincinnati, OH 45229, USA.

Tel: +1 513 636 4785l; fax: +1 513 636 3928; e-mail: Twee.do@chmcc.org

© 2003 Lippincott Williams & Wilkins, Inc.