Journal article
Loss of Reduction in Pediatric Distal Radius Fractures: Risk Factors from a Prospective Multicenter Registry
Journal of the Pediatric Orthopaedic Society of North America, Vol.12, 100206
08/2025
DOI: 10.1016/j.jposna.2025.100206
PMCID: PMC12317416
PMID: 40756142
Abstract
Objectives
Despite numerous single-center studies, uncertainty regarding the management of unstable pediatric distal radius fractures persists. The purpose of this investigation was to report patient factors and fracture characteristics that influence loss of reduction (LOR) or need for secondary procedures following closed reduction of pediatric distal radius fractures in a large, prospective multicenter cohort.
Methods
Children aged 4-18 years old undergoing closed reduction for a displaced distal radius fracture were identified from the multicenter Pediatric Distal Radius Fracture (PDRF) Registry. Radiographic LOR was defined as a change in angulation ≥10° or an increase in translation of ≥2 out of 5 categories. Bivariate analysis and multivariate logistic regressions were performed.
Results
In total, 616 children (69% male) with a mean age of 10.5 ± 3.4 years were included. The majority of subjects sustained bicortical metaphyseal distal radius fractures (68%), followed by Salter-Harris II physeal fractures (26%). The rate of radiographic LOR was 44% (271/616), and 11% (70/616) of fractures shifted ≥20 degrees. On multivariate analysis, metaphyseal bicortical fracture pattern (OR=2.3), pre-reduction translation of ≥51% (OR=2.3), and non-anatomic closed reductions (OR=1.9) independently increased the odds of LOR. Patient age, sex, and BMI were not significant predictors for LOR. Ultimately, 8% of children (47/616) underwent secondary procedures including repeat closed reduction or operative treatment.
Conclusions
Re-displacement of pediatric distal radius fractures after closed reduction is common (44%) and is greatly influenced by fracture characteristics. Roughly 11% of fractures will shift ≥20 degrees after closed reduction and 8% undergo secondary procedures. Bicortical fracture pattern, pre-reduction fracture translation ≥51%, and non-anatomic closed reductions are independent risk factors for re-displacement. Dedicated effort should be made to minimize fracture translation at primary closed reduction, not because of remodeling potential, but to minimize the risk of angulation-driven loss of reduction.
Details
- Title: Subtitle
- Loss of Reduction in Pediatric Distal Radius Fractures: Risk Factors from a Prospective Multicenter Registry
- Creators
- Apurva S. ShahZoe E. BelardoMark L. MillerMichael C. WilleySusan T. MahanDivya TalwarPediatric Distal Radius Fracture (PDRF) Study GroupDonald S. Bae
- Resource Type
- Journal article
- Publication Details
- Journal of the Pediatric Orthopaedic Society of North America, Vol.12, 100206
- DOI
- 10.1016/j.jposna.2025.100206
- PMID
- 40756142
- PMCID
- PMC12317416
- NLM abbreviation
- J Pediatr Soc North Am
- ISSN
- 2768-2765
- eISSN
- 2768-2765
- Publisher
- ELSEVIER
- Grant note
- Pediatric Ortho-paedic Society of North America (POSNA) Directed Research Grant
The PDRF Registry was supported in part by the Pediatric Ortho-paedic Society of North America (POSNA) Directed Research Grant.
- Language
- English
- Electronic publication date
- 05/2025
- Date published
- 08/2025
- Academic Unit
- Orthopedics and Rehabilitation; Injury Prevention Research Center
- Record Identifier
- 9984824180402771
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