Acceptance of angulation in the non-operative treatment of paediatric forearm fractures

Abstract

Forearm fractures are the most common injury in paediatric traumatology. The unique properties of the juvenile skeleton make it possible to cope well with traumatic deformities such as angulation, apposition and displacement. While we make use of these properties, the exact mechanism and degree of healing remains obscure. Different types of forearm fractures require specific treatment options, each with its limitations. A meta-analysis of recent literature was carried out, and together with the opinions of 18 international experts an effort was made to provide insight into the limits of acceptance of angular deformation in the non-operative treatment of paediatric forearm fractures. With this information we constructed graphs (age versus angulation) for each of the eight types of paediatric forearm fractures. In the absence of proper trials, it is our opinion that the presented Isala graphs can provide useful support in the decision-making process of acceptance of angular deformities in paediatric forearm fractures.

Nonoperative Treatment of Both-bone Forearm Shaft Fractures in Children

“…Based on reasonable evidence presented in the literature from both clinical and cadaveric studies, the threshold for acceptable shaft angles for females 8 years or younger and males 10 years or younger were 20 degrees for the distal-third, 15 degrees for the middle-third, and 10 degrees for the proximal-third9,13,19,22–26. In order to account for skeletal maturity according to age and sex, angulations up to 10 degrees were considered acceptable at all shaft levels for females older than 8 and males older than 10 years4,7,13,19,22,25. Failure of non-operative treatment was defined as exceeding these criteria.…”

Think twice before re-manipulating distal metaphyseal forearm fractures in children

“…With increasing age, the degree of tolerable angulation decreases, recommending to accept up to 10°-15°in children aged 9-13 years and up to 5°-10°in children aged 13-15 [6]. Controversy exists about the degree of angulation tolerable [7].…”

Open Intramedullary Kirschner Wire versus Screw and Plate Fixation for Unstable Forearm Fractures in Children

“…22 Although treatment modalities and acceptable levels of malalignment remain controversial, there is a consensus that fracture angulation of >10º is not acceptable in patients older than 10 years and requires surgery. 3,5,20,23 Both intramedullary Kirschner wiring and plating are successful treatment modalities 7,8 and have advantages and disadvantages. Rotational stability is difficult to maintain with intramedullay Kirschner wiring, especially in older children (because of the larger intramedullary canal width).…”