Description
This VTT transcript captures a lecture by Dan Perry discussing the management of distal radius fractures in children. He begins humorously by acknowledging his controversial decisions in medical practice, particularly about whether to surgically treat such fractures. Perry presents evidence supporting the notion that pediatric bones, especially in children aged 4 to 10, often remodel effectively without surgical intervention, challenging traditional views that promote immediate surgical responses to fractures. He cites studies, including one from Posner, which showed that non-operative treatments yielded successful outcomes in children with overriding fractures.
Perry critiques the high rates of surgical complications associated with operations like pinning distal radius fractures, highlighting a specific case where a child's infection led to serious complications, questioning the necessity of surgery in these cases. As he discusses treatment protocols, he emphasizes the need to approach fractures conservatively, suggesting that parents often prefer non-surgical options due to fears associated with anesthesia and surgery. Through examples and clinical insights, he advocates for a shift in treatment paradigms toward non-operative care, providing insights into recent studies—including the CRAFFT study—which aim to validate this approach on a national scale.
The discussion concludes with a series of audience questions addressing the functional outcomes of treated children and practical considerations for managing fractures. Overall, the lecture reflects a significant movement within pediatric orthopedics towards more conservative management strategies, backed by emerging evidence.