Pediatric Proximal Radial Shaft Fractures Treated Nonoperatively Fail to Maintain Acceptable Reduction up to 70% of the Time.

OBJECTIVE: To compare early radiographic malalignment rates of conservatively treated proximal radial shaft fractures to more distal fractures. DESIGN: Retrospective cohort study. SETTING: A pediatric, Level 1 trauma center. PATIENTS/PARTICIPANTS: We identified a group of 401 pediatric patients who were treated for a complete radial shaft fracture at our institution. Of this group, 309 patients met our inclusion criteria for attempted nonoperative management and were evaluated in our study. INTERVENTION: Closed reduction and casting. MAIN OUTCOME MEASUREMENT: The primary outcome of the study was the failure rate of nonoperative management as defined by residual angulation of the radius assessed on follow-up radiographs. RESULTS: Proximal third fractures were significantly more likely to fail conservative treatment (P < 0.0001) as they exceeded angulation criteria 70% (32/46) of the time compared with more distal fractures (33%; 87/263). In terms of halves (P = 0.0003), the proximal half fractures failed 50% (55/111) of the time while 29% (57/198) of distal half fractures failed conservative treatment. Failure of closed reduction and casting was 4.6 times higher (95% confidence interval, 2.3-9.1) in proximal third fractures and 2.4 times greater (95% confidence interval, 1.5-3.9) in proximal half fractures compared with their more distal counterparts. CONCLUSIONS: Given the impressive rate of failure of closed reduction and casting of proximal third radial shaft fractures, the treating orthopaedic surgeon should prudently consider all management options. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.