THE MANAGEMENT OF ISOLATED DISTAL RADIUS FRACTURES IN CHILDREN

In a consecutive series of 175 forearm fractures requiring manipulatio n in children who presented to the John Radcliffe Hospital between 1 J anuary 1991 and 30 June 1992, 23 had isolated distal radius fractures, all of which required manipulation for unacceptable angulation or dis placement. We had previously noted that these fractures had a high inc idence of loss of position leading to malunion. The 23 patients were r andomly allocated to one of two treatment groups: either manipulation and cast alone, or manipulation and percutaneous Kirschner wiring with cast. These two groups were followed up clinically and radiographical ly until union occurred. Those fractures treated by percutaneous wirin g had no significant complications, and all had a satisfactory result. The fractures treated by manipulation and casting alone required furt her manipulation in 10 cases (91%). We conclude that these problematic fractures should be treated by stabilisation with percutaneous wiring .