Primary displacement predicts complications and poorer outcomes after pediatric proximal radius fractures: A retrospective study of 140 fractures

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