Journal of Children's Orthopaedics - 2026-03-25 - Journal Article
Primary displacement predicts complications and poorer outcomes after pediatric proximal radius fractures: A retrospective study of 140 fractures.
Zilliacus K, Nietosvaara Y, Helenius I, Kivisaari R, Kämppä N, Grahn P
Topics
Key Takeaway
Primary displacement ≥3 mm carries a 6.7-fold increased odds of complications in pediatric proximal radius fractures, with surgical treatment itself associated with 5.0-fold greater odds of unfavorable functional outcome.
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Summary
This study examined predictors of complications and functional outcomes in 140 pediatric proximal radius fractures managed at a single center between 2014 and 2019. Displacement ≥3 mm (OR 6.7), physeal involvement (OR 5.1), and higher Judet classification (OR 4.2) independently predicted complications, which occurred in 25% of cases. Unfavorable functional outcomes occurred in 16% and were strongly associated with surgical treatment (OR 5.0) and the presence of complications (OR 9.2).
Key Limitation
Retrospective single-center design with heterogeneous treatment allocation (nonoperative vs. operative) introduces selection bias, as more severely displaced fractures were preferentially treated surgically, confounding the association between surgical treatment and poor outcomes.
Original Abstract
PURPOSE
Pediatric proximal radius fractures frequently lead to complications and unsatisfactory results, yet the medium- to long-term outcomes of these injuries remain insufficiently studied.
METHODS
We treated 140 proximal radius fractures in 138 children (median age 10, range 1-16 years) between 2014 and 2019. Fracture characteristics, treatment, complications, patient-reported, and functional outcomes were assessed at a median follow-up of 6.8 years (range 5-10 years) through clinical assessment or telephone interview in 110 patients (80%).
RESULTS
Less severe fractures (Judet types I-II) were most common (84/140), while 40% were Judet types III-IV. Most fractures (66%) were treated nonoperatively. Complications occurred in 25% of cases and were mainly associated with displacement ≥3 mm (Odds ratio (OR) 6.7, 95% confidence interval (CI) 2.7-19.1), physeal involvement (OR 5.1, 95% CI 2.0-15.7), and higher Judet classification (OR 4.2, 95% CI 1.9-9.7). Unfavorable functional outcomes occurred in 16% (11/67) and were more frequent after surgical treatment (OR 5.0, 95% CI 1.3-19.6) and in patients with complications (OR 9.2, 95% CI 1.8-47.0).
CONCLUSION
In pediatric proximal radius fractures, primary displacement ≥3 mm, higher Judet's class, and physeal involvement increased the risk of complications and unfavorable long-term outcomes.
LEVEL OF EVIDENCE
Prognostic study, Level III.