Rockwood Children CH8

258

SECTION TWO • Upper Extremity

C

Figure 8-24.  ( Continued ) C: Significant remodeling at 5 months after fracture. D: Anatomic remodeling with no physeal arrest.

D

For the reasons cited above, most pediatric distal radius frac- tures can be successfully treated with nonoperative means (no reduction or closed reduction, cast immobilization). General indications for nonoperative treatment include torus fractures, displaced physeal or metaphyseal fractures within acceptable parameters of expected skeletal remodeling, displaced fractures with unacceptable alignment amenable to closed reduction and immobilization, and late-presenting displaced physeal injuries in which late closed reduction has high risk of growth arrest. Contraindications to nonoperative care include open frac- tures, fractures with excessive soft tissue injury or neurovascular compromise precluding circumferential cast immobilization, irre- ducible fractures in unacceptable alignment, unstable fractures failing initial nonoperative care, and fractures with displacement that will not remodel sufficiently to be acceptable long term.

TABLE 8-1. Angular Corrections in Degrees Sagittal Plane Age (yrs) Boys Girls

Frontal Plane

4–9

20

15

15

9–11

15

10

5

11–13

10

10

0

> 13

5

0

0

Acceptable residual angulation is that which will result in total radiographic and functional correction. (Courtesy of B. De Courtivron, MD. Centre Hospitalie Universitaire de Tours. Tours, France.)