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Anales de la Facultad de Medicina
versão On-line ISSN 2301-1254
Resumo
MAURENTE, Mathias; PAGANO, Ignacio e PEREZ, Maria Elena. Displaced distal radius metaphyseal fractures in the growing skeleton: what is the best therapeutic method? Systematized bibliographic review. Anfamed [online]. 2021, vol.8, n.1, e303. Epub 01-Jun-2021. ISSN 2301-1254. https://doi.org/10.25184/anfamed2021v8n1a9.
Introduction:
Distal radius metaphyseal fractures are the most frequent fractures in pediatric age, accounting for 30% of the total. Maintaining the reduction of displaced fractures is not always possible: re-displacement is the main complication of these injuries. Classically, treatment was performed with a maneuver and a cast, although in recent years fixation with Kirschner wire (Kw) has been associated in search of reducing re-displacement. The objective of our work is to identify risk factors in search of the best treatment while being the least aggressive possible.
Materials and methods:
A systematic search was carried out using the PubMed electronic search engine. It reached a total of 4594 articles, which according to the inclusion and exclusion criteria, 15 papers were selected for our bibliographic review.
Results:
It should be noted that most of the articles found are level of evidence III and IV. Our search reflects a re-displacement rate between 20-39% using a cast at 2 weeks; as well as a re-manipulation index between 5-10% of all displaced fractures. Most of the studies analyzed attempt to identify the most important risk factors for the re-displacement of fractures, of which the degree of initial displacement of the fracture and the reduction achieved are highlighted. In turn, other articles assess the results of treatment by stabilization with plaster or fixation with Kirschner wire.
Conclusion:
the initial displacement of the fracture and the reduction achieved in the surgical block (BQ) are the most important risk factors for re-displacement. Although the casting technique is not considered a statistically significant variable, it is considered an important variable in terms of the prognosis of the injury, highlighting the 3-point casting as the main index to be considered. It is considered advisable to associate a Kw in those mounted fractures in which an anatomical reduction in surgical block is not achieved.
