LAUSR

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.