Malunited fractures of the forearm in children

Abstract

Malunion of fractures of the forearm in children can lead to permanent disability. The capacity of the radius and ulna to remodel spontaneously after malunion has been assessed in this study. Forty-nine children who had malunited fractures of the forearm were examined when the remodelling process was complete. It was noted that fractures of the distal third of the radius and ulna led to fewer problems than those of the diaphysis. It was concluded that malunion of the distal third of the radius and the ulna will remodel satisfactorily providing the child is less than 14 years of age. Gross malunion of the midshaft of the radius and ulna will spontaneously correct in an infant but little useful correction of deformity can be anticipated in diaphysial fractures when the child is aged eight years or more.

An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture

“…The residual deformity following malunited fractures does not always correct, especially in older children [6][7][8]. This could cause a loss of forearm motion and result in poor functional outcomes [6,9]; therefore, operative treatment might be needed for the unstable, irreducible or open diaphyseal forearm fractures.…”

Correction of Forearm Malunion Guided by the Preoperative Complaint

“…The relative grip strength was greater than 80% in all but three patients. These three patients (Patients 4,5,14) were all operated on the nondominant side and had a relative grip strength greater than 70% with respect to the healthy side. The mean DASH scores in Groups 1, 2, and 3 were 19 ± 10, 10 ± 18, and 5 ± 6, respectively.…”

“…Forearm fractures in children, therefore, usually are treated with closed reduction and immobilization and only unstable fractures are treated surgically [35]. Recommendations regarding maximum acceptable displacement in children are dependent on age, fracture level, and type of displacement and remain controversial [7,9,14,18,30]. Nonetheless, some malunions of the forearm in children result in functional impairment and a high rate of refracture [5,13,30,41].…”

Results of titanyum elastic intramedullary nailing (TEN) in forearm fractures in children; a retroseceptive analysis of 23 cases

“…Ancak 8-10 yaş üzerinde, 10 derecenin üzerindeki açılanmaların kabul edilmemesi gerektiği bildirilmektedir. 5,6 On derecenin üzerindeki açılanmalar angule kemikte 3-4 mm göreceli kısalmaya neden olmakta ve distal radioulnar eklemde fonksiyon kaybına, interosseoz mesafenin bozulmasına ve önkolun rotasyon hareketinde kısıtlılığa sebep olmaktadır. 5,6 Remodeling kapasitesi çocuğun yaşına, kırık lokalizasyonuna göre değişir.…”

“…Literatürde önkol kırıklarının kabul edilebilir sınırları oldukça değişkenlik göstermekle beraber >10° anguler deformite, >45 0 rotasyonel deformite ve kırık hattında uyumsuzluk kabul edilemez. 5,8 Cerrahi tedavi kapalı redüksiyonun sağlanamadığı ve sürdürülemediği durumlarda, açık kırıklarda, instabil kırıklarda ve patolojik kırıklarda uygulanır. 2,9,10 Çocuklarda önkol çift kırıklarının cerrahi tedavisinde intramedüller çivileme ve plak ile tespit tespit kullanılmaktadır.…”