Forearm fractures in children: avoiding redisplacement

Haddad, F. S.; Williams, Robert Lee

doi:10.1016/0020-1383(95)00136-0

Cited by 90 publications

(90 citation statements)

References 5 publications

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“…However, we noted a relatively low rate of in-cast redisplacement after nonoperative reduction (9 of 111 patients). This finding, together with reports that fracture redisplacements usually occur within 2 weeks after initial reduction [16]-which was also true for our patients-may indicate that radiographic follow-up at 2 weeks after initial reduction will detect almost all fracture redisplacements, when remanipulation can still be performed. Therefore, we suggest that the radiographic examinations at 1 week and again at 3 weeks during treatment are not necessary in most cases.…”

Section: Discussionsupporting

confidence: 89%

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Chen

Katz

Weigl

et al. 2008

Journal of Children's Orthopaedics

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Introduction A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China. Methods The sample consisted of 202 consecutive children (mean age 7 years; range 3-12 years) with closed forearm fractures treated nonoperatively. Children with open, growth-plate fractures or fractures associated with dislocation of the nearby joint (i.e., monteggia fractures) were excluded. In 28 children who had torus fractures, radiographic examination was performed at the time of cast removal, 3 weeks after the start of treatment. In 63 children who had stable fractures that did not require reduction (undisplaced or minimally displaced, complete or greenstick), radiographic examination was performed 1 week after the start of treatment and again at cast removal 4-6 weeks later. In the remaining 111 children with complete, displaced, or greenstick fractures (all with angulation of more than 15°) who underwent closed reduction, an additional X-ray was taken 2 weeks after cast placement. All children (except those with torus fractures) were followed clinically, without further radiographic examination, for 3 months after cast removal. Results Radiographs at cast removal showed good union in all stable fractures, indicating that additional X-rays on cast removal would have had no added value. In the children with unstable fractures, only 9 showed redisplacement with angulation of more than 15°on repeated X-rays during the first 2 weeks after cast placement. All 9 underwent successful re-reduction. On clinical evaluation 3 months after cast removal, all patients in the sample had full range of elbow and forearm motion. Repeated fracture did not occur in any of the patients. Conclusions On the basis of these results, radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures. At the time of cast removal, if clinical examination does not show signs of nonunion or malalignment, no radiographic examination is necessary.

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Section: Discussionsupporting

confidence: 89%

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Chen

Katz

Weigl

et al. 2008

Journal of Children's Orthopaedics

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“…Proctor et al [10] identified two factors as the more important ones: an initial complete displacement and failure to achieve a perfect reduction. Haddad and Williams [11] reported that a perfect anatomical reduction was the most important favourable prognostic factor. Zamzam and Khoshhal [1] found that the initial displacement of the fracture was the most significant factor affecting outcome.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Initial articles focussed on fracture/surgeon related factors of re-displacement [1,10,11]. A high quality cast application in children's forearm and distal radius fractures has always been a goal; however, an objective assessment was not directly done until Chess et al [13] defined the "cast index".…”

Section: Casting Indicesmentioning

confidence: 99%

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Paediatric forearm and distal radius fractures: risk factors and re-displacement—role of casting indices

Mazzini

Martín

2009

International Orthopaedics (SICOT)

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Forearm fractures represent one of the most common fractures in children aside from clavicle fractures, and the distal radius is the most common fracture site accounting for 20-30% of these fractures. Maintaining acceptable reduction is not always possible, and redisplacement or re-angulation is the most commonly reported complication. Factors leading to this complication can be broadly divided into three groups: fracture-, surgeon-and patient-related. The quality of casting has been historically measured subjectively. The description of several casting indices by different authors has been a major undertaking, attempting to address objective assessment of this factor. The following have been described: cast index, padding index, gap index, three point index and second metacarpal-radius angle. For distal radius fractures we think that the three point index is the most valuable measurement for predicting re-displacement among surgeon related factors; this index has not been used in forearm fractures in which the rest of the indices seem to be useful in predicting re-displacement. The casting indices should not be interpreted as a separate issue but in conjunction with fracture characteristics and patient factors.

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“…Nevertheless, remanipulation rates of 20-39% are reported [4,[9][10][11][12][13], with one study showing a redisplacement rate of 90% in isolated radius fractures [2].…”

Section: Introductionmentioning

confidence: 99%

Treating Displaced Distal Forearm Fractures in Children

Schneider

Staubli

Kubat

et al. 2007

Eur J Trauma Emerg Surg

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Purpose: Distal forearm fractures are among the most common fractures in children. In the past few years the option of percutaneous pinning has gained more attention in the treatment of unstable fractures. However, it remains unclear in which cases a fracture or its reduction should be considered unstable. Study Design: In order to evaluate which type of fractures profit most from additional pinning after closed reduction, we performed a retrospective analysis of 225 consecutive cases using the recently published AO pediatric classification of long bone fractures. Results: After closed reduction, position in the cast was lost in 23% of the cases. The proportion of unstable reductions was much higher in completely displaced fractures. The amount of dislocation was more important than the type of fracture according to the AO classification proposal. Conclusions: Fully displaced fractures should always be reduced in a setting with pins immediately available. If anatomical reduction cannot be achieved, pinning is advocated. The AO proposal for pediatric long bone fracture classification could be a useful tool to render the diverse studies more comparable. However, the important feature of complete versus subtotal displacement is lacking.

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Forearm fractures in children: avoiding redisplacement

Cited by 90 publications

References 5 publications

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Paediatric forearm and distal radius fractures: risk factors and re-displacement—role of casting indices

Treating Displaced Distal Forearm Fractures in Children

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