Presenter Status
Resident/Psychology Intern
Abstract Type
Research
Primary Mentor
Micah K. Sinclair, M.D.
Start Date
11-5-2023 11:30 AM
End Date
11-5-2023 1:30 PM
Presentation Type
Abstract
Description
Introduction: Currently, there is little information regarding risk factors for failure of nonoperative treatment in Salter-Harris II distal radius fractures (SHII-DRF). Our purpose is to identify predictors of which patients will require acute surgery and which will develop late malunion based on degree of deformity and skeletal maturity.
Methods: This was a review of SHII-DRFs in patients 9 to 18 years of age, from 2017-2020. Demographics, initial displacement, displacement post-reduction, and displacement after cast removal were evaluated. Skeletal maturity was determined using Sander’s classification. These values were compared between patients who underwent casting alone, underwent acute surgery, or required late malunion correction. Classification and Regression Tree (CART) models were also fit to identify predictors of surgical intervention and late malunion.
Results: 271 (70% male) SHII-DRFs were identified, of which 34 cases (13%) underwent surgical intervention with CRPP or ORIF. Twenty-two (65%) surgical cases were acute (median 9.5 days, IQR 3.2-14 days) and 12 (35%) cases were performed to correct late malunion (median 459.5 days, IQR 325.5-542 days). No patients who underwent acute surgery developed malunion. As shown in Table 1, the late malunion group tended to be older and have greater tilt in the dorsal direction post-cast removal. The CART model (Figure 1) correctly classified 94% of acute surgery patients with a sensitivity of 55% and specificity of 97%. A second CART model (not shown) identified greater degree of dorsal tilt post-cast removal as the strongest predictor of malunion (misclassification 4%, sensitivity 42%, specificity 97%).
Conclusion: In SHII distal radius fractures, persistent dorsal angulation after casting was associated with late malunion. Increased Sander’s class and magnitude of deformity in all planes following closed reduction and casting was associated with acute surgery. These cutoff values for degree of deformity and skeletal maturity can be used to predict need for acute surgery.
MeSH Keywords
fracture; radius; salter harris; trauma; orthopaedic
Indications for Early Surgical Intervention in Adolescents with Salter-Harris II Distal Radius Fractures
Introduction: Currently, there is little information regarding risk factors for failure of nonoperative treatment in Salter-Harris II distal radius fractures (SHII-DRF). Our purpose is to identify predictors of which patients will require acute surgery and which will develop late malunion based on degree of deformity and skeletal maturity.
Methods: This was a review of SHII-DRFs in patients 9 to 18 years of age, from 2017-2020. Demographics, initial displacement, displacement post-reduction, and displacement after cast removal were evaluated. Skeletal maturity was determined using Sander’s classification. These values were compared between patients who underwent casting alone, underwent acute surgery, or required late malunion correction. Classification and Regression Tree (CART) models were also fit to identify predictors of surgical intervention and late malunion.
Results: 271 (70% male) SHII-DRFs were identified, of which 34 cases (13%) underwent surgical intervention with CRPP or ORIF. Twenty-two (65%) surgical cases were acute (median 9.5 days, IQR 3.2-14 days) and 12 (35%) cases were performed to correct late malunion (median 459.5 days, IQR 325.5-542 days). No patients who underwent acute surgery developed malunion. As shown in Table 1, the late malunion group tended to be older and have greater tilt in the dorsal direction post-cast removal. The CART model (Figure 1) correctly classified 94% of acute surgery patients with a sensitivity of 55% and specificity of 97%. A second CART model (not shown) identified greater degree of dorsal tilt post-cast removal as the strongest predictor of malunion (misclassification 4%, sensitivity 42%, specificity 97%).
Conclusion: In SHII distal radius fractures, persistent dorsal angulation after casting was associated with late malunion. Increased Sander’s class and magnitude of deformity in all planes following closed reduction and casting was associated with acute surgery. These cutoff values for degree of deformity and skeletal maturity can be used to predict need for acute surgery.
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