Does an 11-year-old female with a transverse fracture through the distal radial metaphysis and a corresponding mild buckle fracture of the distal ulnar metaphysis require reduction?

From the Guidelines

This fracture likely needs to be reduced due to the presence of volar angulation and impaction, which suggests significant displacement and less remodeling potential. The X-ray findings describe a distal radius fracture with volar angulation and impaction, along with an associated ulnar buckle fracture in an 11-year-old female. Pediatric distal radius fractures with more than 10-15 degrees of angulation typically require reduction, especially with volar angulation which has less remodeling potential than dorsal angulation 1. Key considerations for reduction include:

• The presence of impaction and cortical buckling, which suggests significant displacement
• The need for closed reduction under procedural sedation or regional anesthesia, followed by cast immobilization for 4-6 weeks
• The application of a well-molded long-arm cast initially, potentially converting to a short-arm cast after 2-3 weeks once early healing is confirmed
• The importance of follow-up X-rays at 1 week to ensure the reduction is maintained, as loss of reduction is common in pediatric fractures While children have excellent remodeling potential, volar angulation tends to remodel less completely than dorsal angulation, making proper reduction important for optimal long-term function and appearance of the wrist 1. Current guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) support the use of evidence-based treatment decisions for distal radius fractures, including the consideration of reduction for fractures with significant displacement or angulation 1.

From the Research

Fracture Description

• The 11-year-old female patient has a transverse fracture through the distal radial metaphysis with slight volar angulation and impaction of the fracture fragment, as well as volar cortical buckling.
• There is a corresponding mild buckle fracture of the distal ulnar metaphysis with slight volar angulation of the fracture fragment.

Need for Reduction

• The decision to reduce the fracture depends on the degree of volar angulation and the stability of the distal radioulnar joint.
• According to the study 2, volar angulation deformities of the distal radius should be corrected to 10° of volar tilt when the triangular fibrocartilage complex is intact.
• However, the study 3 emphasizes the importance of recognizing and rigidly repairing volar marginal fragments to maintain reduction and allow healing.
• In this case, the fracture has slight volar angulation, but the study 2 suggests that correction to 10° of volar tilt may be necessary to ensure distal radioulnar joint stability.

Management Considerations

• The management of the fracture should involve a complete preoperative and intraoperative evaluation, as emphasized in the study 3.
• The study 4 suggests that ibuprofen may be a bone-safe analgesic treatment after Colles' fracture, but this does not directly address the need for reduction.
• The studies 5 and 6 discuss pain management after operative treatment of extremity fractures, but do not provide direct evidence for the need for reduction in this specific case.