A pediatric distal radius fracture is a fracture of one of the bones in the wrist, you may have heard it referred to as a wrist fracture. Typically, this is a traumatic injury caused by a fall on an outstretched hand. Children present a unique population because their bones are still growing. In some instances the growth plate is involved in the fracture and requires special attention. These fractures range in their severity depending on the age of the child and the energy of the injury mechanism.
Pediatric distal radius fractures are most commonly diagnosed with x-rays. Some fractures are evident from the deformity that is visualized just by looking at the injured limb. However, all distal radius fractures will at least get x-rays and some will need a CT scan or an MRI.
Depending on the severity of your child’s injury the patient will either be treated with cast immobilization for approximately 6-8 weeks, or may require surgery. The type of surgical technique is influenced by many different factors. The age of the patient is a main driving factor in choosing the appropriate type of surgical fixation.
Because children continue to grow and the implanted wire, pin or plate do not, it is desirable to use something that can be removed with relative ease once the fracture is completely healed. This typically is accomplished with pins inserted through the skin that can be easily removed in the office.
Some fractures are difficult to reduce and thus maintain a reduction with simple pins and so require placement of plates and screws. Depending on the child age and other various factors, these plates and screws will be left in place or removed.
In children the idea of “less is more,” typically applies. Many times a child will be taken to the OR planning to try closed reduction alone. If closed reduction fails, the level of intervention is escalated. First closed reduction and percutaneously inserted pins is attempted. If this fails, an incision is made to help with direct reduction of the fracture with pin insertion, and finally open reduction with plate and screw fixation.
If your child has had pins inserted, they typically will be sticking out from the skin and covered with protective caps. These pins stay in place for an average of 4-6 weeks and are then removed in the office. These patients are placed in a splint or cast at the time of surgery and will need to be immobilized for approximately 6 weeks.
Some patients will be sent to a hand therapist for creation of a custom molded splint. If this is the case then pin site care will be needed while the pins are in place. This consists of a daily gentle cleaning of the pin site with a Q-tip and a 50/50 mixture of hydrogen peroxide and water. The hand therapist will go over exactly how to do this.
As long as the pins are in place, they need to stay clean and dry. This requires showering or bathing with a bag over the arm to keep the pin sites dry. Once pins are removed the patient is able to get the pin holes wet 48 hrs after pin removal. Typically range of motion is initiated at 4 weeks and strengthening at 6 weeks. Full activity is usually restricted until approximately 8-10 weeks. Release to full activity must always be confirmed with your surgeon.
If a plate and screws have been used to fix the fracture, again a splint or cast will be applied. Some of these patients will also be sent to a hand therapist for a similar custom splint. This splint will be worn for 4-6 weeks. If a patient has a removable splint made by a hand therapist they are allowed to shower and get their incision wet once they have been seen by therapy.
Casts and surgical dressings are never to get wet. Patients are not allowed to swim or submerge their incision until 3 weeks after surgery. This may be even longer if there are wound complications. Typically range of motion is initiated at 4 weeks and strengthening at 6 weeks. Full activity is usually restricted until approximately 8-10 weeks. Release to full activity must always be confirmed with your surgeon.