Immobilisation of forearm fractures in children

Chen, Bo-chang; Yang, Jie; Zhigang, W.; Weigl, Daniel; Bar‐On, Elhanan; Katz, Kalman

doi:10.1302/0301-620x.87b7.15774

Cited by 38 publications

(20 citation statements)

References 5 publications

(8 reference statements)

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“…Previous studies have found a re-displacement rate of 7–27% in non-operatively treated forearm fractures, whereas we found a rate of 34% (Monga et al 2010, Kay et al 1986, Voto et al 1990, Chan et al 1997, Jones and Weiner 1999, Bochang et al 2005, Schmittenbecher 2005). This higher rate of re-displacement might be explained by our strict malunion criteria, the prospective follow-up with scheduled radiographs, our test for stability, and the type of cast (non-circumferential cast applied directly after reduction).…”

Section: Discussioncontrasting

confidence: 87%

“…Using the grading system (Daruwalla 1979), we found that 21% (AEC) and 33% (AEC and BEC) had excellent results, whereas other authors have found excellent results in 44–100% of such children (Daruwalla 1979, Kay et al 1986, Price et al 1990, Jones and Weiner 1999, Bochang et al 2005, Boero et al 2007). The modified grading system (Price et al 1990) resulted in 33% and 48% excellent results in our 2 groups, as compared to 82% in another study (Price et al 1990).…”

Section: Discussionmentioning

confidence: 69%

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Conversion to below-elbow cast after 3 weeks is safe for diaphyseal both-bone forearm fractures in children

Colaris¹,

Allema²,

Biter³

et al. 2013

Acta Orthopaedica

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BackgroundIt is unclear whether it is safe to convert above-elbow cast (AEC) to below-elbow cast (BEC) in a child who has sustained a displaced diaphyseal both-bone forearm fracture that is stable after reduction. In this multicenter study, we wanted to answer the question: does early conversion to BEC cause similar forearm rotation to that after treatment with AEC alone?Children and methodsChildren were randomly allocated to 6 weeks of AEC, or 3 weeks of AEC followed by 3 weeks of BEC. The primary outcome was limitation of pronation/supination after 6 months. The secondary outcomes were re-displacement of the fracture, limitation of flexion/extension of the wrist and elbow, complication rate, cast comfort, complaints in daily life, and cosmetics of the fractured arm.Results62 children were treated with 6 weeks of AEC, and 65 children were treated with 3 weeks of AEC plus 3 weeks of BEC. The follow-up rate was 60/62 and 64/65, respectively with a mean time of 6.9 (4.7–13) months. The limitation of pronation/supination was similar in both groups (18 degrees for the AEC group and 11 degrees for the AEC/BEC group). The secondary outcomes were similar in both groups, with the exception of cast comfort, which was in favor of the AEC/BEC group.InterpretationEarly conversion to BEC cast is safe and results in greater cast comfort.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 69%

Conversion to below-elbow cast after 3 weeks is safe for diaphyseal both-bone forearm fractures in children

Colaris¹,

Allema²,

Biter³

et al. 2013

Acta Orthopaedica

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“…Forearm fractures represent one of the most common fractures in children aside from clavicle fractures [1][2][3], and the distal radius is the most common fracture site accounting for 20-30% of these fractures [4][5][6][7][8]. Metaphyseal fractures are more common than fractures of the diaphysis, followed by epiphyseal fractures [4,9].…”

Section: Introductionmentioning

confidence: 99%

“…Maintaining acceptable reduction is not always possible and re-displacement or re-angulation during cast treatment may occur; this is the most commonly reported complication in paediatric forearm fractures [2,[11][12][13]. Very high rates of unacceptable degrees of displacement after the initial fracture reduction have been reported.…”

Section: Introductionmentioning

confidence: 99%

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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“…One such paper showed excellent results with no displacements when the elbow was immobilised in an extended position and a 17.6% redisplacement with the elbow immobilised in a flexed position [2].…”

Section: Discussionmentioning

confidence: 99%

Paediatric forearm fractures: the increasing use of elastic stable intra-medullary nails

Cumming¹,

Mfula²,

Jones³

2007

International Orthopaedics (SICO

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This paper entails a clinical review of outcomes and complications of 19 consecutive paediatric patients having undergone elastic stable intramedullary nailing for diaphyseal forearm fractures over a one year period. The mean age of patients was 9 years. The majority were male with a ratio of 17:2. In this group there were two patients with grade 1 open fractures. Four of the fractures required open reduction due to difficulty in reduction and soft tissue interposition. All fractures went on to osseous union with minimal deformity and full recovery. There were three complications which included one EPL rupture requiring delayed repair, one EPB partial rupture repaired at time of surgery, and one superficial radial nerve injury. Two patients also presented with nails penetrating the skin prior to removal. Elastic stable intramedullary nails offer good fixation to control deformity in midshaft forearm fractures for paediatric patients. However there is a high rate of possible complications around the radial insertion point.Résumé L'étude clinique des complications à propos d'une série consécutive de 19 patients nécessitant l'utilisation d'un enclouage élastique stable intra médullaire pour fracture de la diaphyse des os de l'avant-bras a été réalisée. Cette étude a été réalisée sur une période d'un an. L'âge moyen des patients était de 9 ans avec une majorité de garçons (17 garçons et 2 filles). Dans ce groupe, trois patients présentaient une fracture ouverte de grade I. 4 patients ont nécessité une réduction à ciel ouvert secondaire à une interposition tissulaire. Trois complications ont été constatées, deux ruptures tendineuses et une lésion superficielle du nerf radial. 2 patients présentaient également une lésion cutanée secondaire en regard des clous. L'enclouage intra médullaire élastique stable permet une excellente fixation de la déformation de la fracture des deux os de l'avant bras chez les enfants mais cependant, le taux de complications est relativement élevé au niveau du point d'insertion radial.

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Immobilisation of forearm fractures in children

Cited by 38 publications

References 5 publications

Conversion to below-elbow cast after 3 weeks is safe for diaphyseal both-bone forearm fractures in children

Conversion to below-elbow cast after 3 weeks is safe for diaphyseal both-bone forearm fractures in children

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

Paediatric forearm fractures: the increasing use of elastic stable intra-medullary nails

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