Patterns and short term outcome of non-operative management of pediatric wrist fractures seen at Mulago National Referral Hospital

Abstract

Background: Management for most pediatric wrist fractures is non-operative with closed reduction and immobilization. At Mulago National Referral Hospital (MNRH), the prevalence of pediatric wrist fractures among pediatric upper limb fractures is 53% and are mostly managed non - operatively. This treatment modality has been associated with complications, marked variation in outcomes within and between countries. General Objectives: To describe the pattern and short-term outcome of non-operative management of pediatric wrist fractures seen at MNRH Methodology: The study consecutively enrolled 102 pediatrics wrist fractures seen at MNRH and managed non-operatively. The pattern of wrist fractures was assessed radiologically at presentation. Participants were followed up prospectively to determine the radiological and functional outcomes at 4 weeks and repeated functional outcome at 6 weeks post injury. The functional outcome was assessed using the Price criteria. The mal-union and fracture union radiological outcomes were assessed using the acceptable deformity tool and Radius Union Scoring System (RUSS) respectively. The correlation between functional and radiological outcomes was analyzed. Results: 98 participants completed the study with a median age of 12 years.73.5% of the participants were boys. 54.9 % had ulna and radius bone fractures with metaphyseal wrist fractures (83.4 %) being the most common type and Salter Harris type II being the most common physeal/epiphyseal fractures. 61.6%, 29% of participants had angulation and mal-union respectively.88% of participants had satisfactory outcome at 4 weeks and 89.7% at 6 weeks. There was a positive relationship between Angulation and functional outcome. Conclusion: Non - operative management of pediatric wrist facture is a viable option since the functional outcome is mostly satisfactory following this treatment method.