A new reduction technique for completely displaced forearm and wrist fractures in children: A biomechanical assessment and 4-year clinical evaluation

BACKGROUND: Most pediatric distal radius fractures are treated with closed methods, however, in recent years an increasing number of fractures are treated with operative management. Multiple reduction techniques are described in the orthopaedic literature but no recent advances have been made in the closed management of these injuries. We describe the efficacy of new, single-provider manual reduction technique that improves reduction efficacy and we separately show its biomechanical superiority to other common techniques. METHODS: Review the results of a new reduction technique, known as the Lower Extremity-aided Fracture Reduction (LEAFR) maneuver, used on a specific cohort of consecutively treated patients at a single institution over a 4-year period with bayoneted distal radius fractures. Intention-to-treat methodology and descriptive statistics are utilized to analyze accuracy of reduction, need for operative intervention, residual deformity, and complications. In addition, perform a biomechanical comparison between the LEAFR maneuver, the 2 person traction counter-traction method and finger traps. RESULTS: The technique allowed 24 consecutively treated, bayoneted distal radius fractures to be reduced from average translational and shortening deformities of 11.4 and 6.5 mm to 2.1 and 0.4 mm, respectively (P<0.0001). Two (8%) of the 24 patients had failure to eliminate bayonet displacement, whereas only 3 patients (12.5%) ultimately required operative intervention. No cases of growth arrest were noted. A biomechanical assessment of the maneuver showed the ability to generate an average of 597.8 Newtons (N) of axial traction which is statistically significant in comparison to other accepted methods of reduction. CONCLUSIONS: The LEAFR is a clinically effective and biomechanically sound technique for reduction of bayoneted distal radius fractures in children. It is a simple, reproducible technique not reliant on equipment or additional skilled providers. In addition, it results in decreased rates of operative management and represents advancement in the treatment of pediatric distal radius fractures.