Surgical pinning after loss of reduction in Salter–Harris type I–II distal radius fractures does not improve outcomes: A propensity matched cohort study

The objective of this study is to compare the clinical and radiological outcomes of conservative vs. surgical management in pediatric patients with Salter–Harris types I and II distal radius fractures who experienced loss of reduction following initial closed reduction. This retrospective matched cohort study included pediatric patients under 16 years of age treated for Salter–Harris types I and II distal radius fractures with documented loss of reduction. Patients were matched based on age, sex, and Salter–Harris fracture type. Functional outcomes were assessed using the Mayo wrist score, disabilities of the arm, shoulder, and hand (DASH), and patient-rated wrist evaluation (PRWE) scores. Radiographic parameters, including radial height, dorsal angulation, dorsal translation, radial inclination, and physeal alignment, were evaluated at initial trauma, posttreatment, and final follow-up. A total of 96 patients were included in the study: 72 were treated conservatively, and 24 underwent surgical pinning. The mean age was 10.2 ± 2.1 years in the conservative group and 11.1 ± 1.8 years in the surgical group. The overall mean follow-up duration was 60.9 ± 11.5 months. At final follow-up, there were no statistically significant differences between the conservative and surgical groups in Mayo (97.6 ± 2.8 vs. 96.8 ± 4.1; P = 0.45), DASH (1.4 ± 2.6 vs. 2.1 ± 3.3; P = 0.27), or PRWE scores (0.7 ± 1.5 vs. 1.4 ± 2.3; P = 0.17). Radiographic parameters, including dorsal angulation [0° (0–4.4°) vs. 0° (0–0°), P = 0.12] and dorsal translation (0 vs. 0%; P = 0.06), were similarly restored in both groups. In pediatric Salter–Harris types I and II distal radius fractures with loss of reduction, continued conservative management provided outcomes comparable to surgical pinning. These findings suggest that surgery may not be routinely necessary, particularly in patients with remodeling potential. Level of evidence: Level III, retrospective comparative series .