Mateusz Gładysz FESSH prep

FESSH prep Wrist trauma

Paediatric distal radius and physeal fractures

Last reviewed v1.0

FESSH-093Wrist trauma●○○ basic

Regarding distal radius and physeal fractures in children:

  1. 1.In a population-based study of physeal fractures, Salter–Harris type II was the commonest fracture pattern.

  2. 2.Premature growth disturbance is more frequent after physeal injury of the distal radius than after physeal injury of the distal ulna.

  3. 3.A well-moulded below-elbow cast can be as effective as an above-elbow cast for displaced fractures of the distal third of the forearm in children aged 4 years or older.

  4. 4.For a torus (buckle) fracture of the distal radius, rigid immobilisation gives less pain at 3 days than the offer of a soft bandage and immediate discharge.

  5. 5.Residual coronal-plane (radial) angulation after a distal radius fracture in a skeletally immature child does not remodel.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-093
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In a population-based study of physeal fractures, Salter–Harris type II was the commonest fracture pattern.

    True

    Peterson's Olmsted County study identified 951 physeal fractures in 850 children over 10 years. Salter–Harris type II accounted for 54%, although 16% of fractures did not fit the Salter–Harris scheme, which led to a new classification. The commonest site in that population was the phalanges of the fingers (37%).

    • Peterson HA, Madhok R, Benson JT, Ilstrup DM, Melton LJ. Physeal fractures: Part 1. Epidemiology in Olmsted County, Minnesota, 1979-1988. J Pediatr Orthop. 1994;14(4):423-30. PMID 8077422

  2. 2. Premature growth disturbance is more frequent after physeal injury of the distal radius than after physeal injury of the distal ulna.

    False

    In Cannata's series followed for a mean of 25.5 years, shortening of 1 cm or more followed 4.4% of 157 distal radial physeal injuries but 3 of only 6 distal ulnar physeal injuries. A later series of 56 distal ulnar physeal fractures found growth disturbance or arrest in about 20%, more often after displaced or Salter–Harris III–IV fractures.

    • Cannata G, De Maio F, Mancini F, Ippolito E. Physeal fractures of the distal radius and ulna: long-term prognosis. J Orthop Trauma. 2003;17(3):172-9; discussion 179-80. PMID 12621255
    • Lee J, Värk PR, Mendenhall SD, Chang B, Buttrick E, Shah AS. Physeal Fractures of the Distal Ulna: Incidence and Risk Factors for Premature Growth Arrest. J Pediatr Orthop. 2024;44(3):151-156. PMID 38062866

  3. 3. A well-moulded below-elbow cast can be as effective as an above-elbow cast for displaced fractures of the distal third of the forearm in children aged 4 years or older.

    True

    Webb's randomised trial of 113 children found no difference between short- and long-arm casts in the change of displacement, angulation or deviation during treatment. Fractures that lost reduction had higher cast indices, indicating poor moulding, and children in short-arm casts missed fewer school days and needed less help with daily activities.

    • Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am. 2006;88(1):9-17. PMID 16391244

  4. 4. For a torus (buckle) fracture of the distal radius, rigid immobilisation gives less pain at 3 days than the offer of a soft bandage and immediate discharge.

    False

    The FORCE equivalence trial randomised 965 children aged 4–15 years with a distal radius torus fracture. Pain at 3 days was equivalent with the offer of a bandage and with rigid immobilisation, and there were no between-group differences in pain or function over 6 weeks of follow-up.

    • Perry DC, Achten J, Knight R, Appelbe D, Dutton SJ, Dritsaki M, et al.. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet. 2022;400(10345):39-47. PMID 35780790

  5. 5. Residual coronal-plane (radial) angulation after a distal radius fracture in a skeletally immature child does not remodel.

    False

    Lynch's retrospective study of 36 children aged 4–12 years with more than 10° of coronal angulation found remodelling at a mean of 2.3° per month, from a median peak of 17° to 3.35° at final follow-up. The authors concluded that remodelling occurs predictably, even in the coronal plane.

    • Lynch KA, Wesolowski M, Cappello T. Coronal Remodeling Potential of Pediatric Distal Radius Fractures. J Pediatr Orthop. 2020;40(10):556-561. PMID 32427798