Radial Fractures in 11-Year-Olds: Treatment and Risks

Q: Radial Fractures in 11-Year-Olds: Treatment and Risks

Hello： 1. <br>To prevent deformities, it is essential to provide stable fixation and protect the growth plates from excessive injury. <br>Pediatric fractures are typically stabilized with percutaneous pins and cast immobilization, which is usually sufficient. <br>Proper anesthesi

Radial fracture in an 11-year-old child?

Dear Doctor,
An 11-year-old child fell off a bicycle on July 25 and fractured the radius near the wrist.
Initial treatment involved closed reduction and casting, with weekly follow-ups.
The physician indicated that if there was no displacement, surgery would not be necessary.
On August 14, the physician noted excessive displacement, necessitating surgery.
On August 18, the child underwent surgery under general anesthesia for re-alignment and had two pins inserted for fixation (with exposed pins).
Due to adhesions, an additional incision was made to remove some of the adhesions.
During the postoperative follow-up, the physician mentioned that only part of the adhesions could be removed, as removing them near the growth plate could affect development, resulting in a 10% risk of malunion in the future.
I would like to ask the physician:
1.
Are there any methods to prevent malunion?
2.
If malunion occurs, how should it be managed? Would corrective surgery be necessary?
3.
Considering the growth rate in children, how long will it take to determine if there is poor healing?
Thank you for your time in responding.

Amber, 40~49 year old female. Ask Date: 2020/08/27

Dr. Li Wenhong reply Orthopedics

Hello: 1.
To prevent deformities, it is essential to provide stable fixation and protect the growth plates from excessive injury.
Pediatric fractures are typically stabilized with percutaneous pins and cast immobilization, which is usually sufficient.
Proper anesthesia (general anesthesia) during reduction can help avoid excessive damage to the growth plates.
2.
If a deformity is already present, the decision to correct it depends on the degree of deformity and the ability of the fracture site to remodel.
3.
Pediatric fractures typically heal in about 6-8 weeks, followed by a 3-6 month observation period to assess for remodeling.
Changhua Hospital, Orthopedics, Li Wen-Hong.

Reply Date: 2020/08/27

More Info

Understanding radial fractures in children, particularly in an 11-year-old, involves a careful consideration of the nature of the injury, the treatment options, and the potential risks associated with healing. Radial fractures, especially those occurring near the wrist, are common in pediatric populations due to the high activity levels and the propensity for falls.
In your case, the initial treatment involved closed reduction and casting, which is a standard approach for non-displaced fractures. However, the subsequent need for surgery indicates that the fracture had significant displacement, which can complicate healing and function. The use of pins for stabilization is a common practice, especially in cases where there is a risk of malunion or nonunion.

1. Preventing Malunion
Preventing malunion, or improper healing of the bone, primarily involves ensuring proper alignment and stabilization of the fracture during the healing process. Here are some strategies:
- Regular Follow-ups: Frequent monitoring through X-rays can help assess the alignment of the fracture and ensure that it is healing correctly.

- Physical Therapy: Once the initial healing has occurred, physical therapy can help improve range of motion and strength, which may indirectly support proper healing.

- Adherence to Medical Advice: Following the doctor's instructions regarding activity restrictions and rehabilitation exercises is crucial.

2. Managing Malunion
If malunion occurs, the treatment will depend on the severity and the specific nature of the deformity. Options include:
- Observation: In some cases, if the malunion does not significantly affect function, it may be monitored without immediate intervention.

- Surgical Correction: If the malunion results in functional impairment or significant deformity, a corrective surgery may be necessary. This could involve osteotomy (cutting the bone to realign it) or additional fixation methods.

3. Timeline for Assessing Healing
In children, the healing process can vary significantly based on age, the specific bone involved, and the nature of the fracture. Generally, you can expect:
- Initial Healing: Most fractures in children begin to show signs of healing within 4-6 weeks.

- Assessment of Malunion: If there are concerns about malunion, it can typically be assessed around the 6-8 week mark post-injury. However, definitive conclusions about healing quality may take longer, often around 3-6 months, depending on the child's growth and development.

Additional Considerations
- Growth Plates: Since the fracture is near the growth plate, there is a risk that improper healing could affect future growth. This is why careful monitoring is essential.

- Long-term Follow-up: Children with fractures near growth plates should have long-term follow-up to monitor for any late complications, including growth disturbances or functional issues.

Conclusion
In summary, while radial fractures in children can be concerning, with appropriate management, the majority heal well. Regular follow-ups, adherence to treatment protocols, and proactive management of any complications are key to ensuring the best outcomes. If there are any concerns about the healing process or potential malunion, it is essential to discuss these with the treating physician, who can provide tailored advice based on the specific circumstances of the injury.

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