Redisplacement After Closed Reduction of Forearm Fractures in Children

Voto, Stephen J.; Weiner, Dennis S.; Leighley, Bonnie

doi:10.1097/01241398-199010010-00015

Cited by 26 publications

(42 citation statements)

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“…Diaphyseal radial and ulnar fractures make up approximately one-eighth of the total number of forearm fractures. As the bone remodeling potential in children is high, most forearm fractures can be successfully treated with immobilisation by plaster casting following closed reduction [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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

Teoh

Chee

Shortt

et al. 2009

Journal of Children's Orthopaedics

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Purpose Intramedullary (IM) nailing and plating are recognised fixation methods for both-bone midshaft forearm fractures. Although both methods are effective, IM nailing has recently been the accepted operative treatment for the paediatric population. The aim of the study was to compare the differences in the radiographic and functional outcomes of an age-and sex-matched cohort of children following treatment by IM fixation or plate fixation with screws for an unstable both-bone diaphyseal fracture. Methods A retrospective study was conducted and 17 age-and sex-matched pairs of patients returned for a research review clinic. The average age of our patients was 11.6 years at follow up, with 11 boys and six girls in each group. The mean follow up was similar in both groups (IM 31.5 months, plating 31.8 months). Results Plating and IM nailing result in good or excellent functional and radiological outcomes. Radiographs at the review clinic showed complete healing in the plating group, with reconstitution of the radial bow. Three patients in the IM group did not regain the natural radial bow radiographically. There were no significant differences between both groups for maximum radial bow and its location (P [ 0.05). However, the maximum radial bow was significantly different from normative values in both groups (P = 0.003 plate, P = 0.005 IM). No non-union or malunion was observed. There were no significant differences in the loss of forearm motion and grip strength between both groups. There was no difference in the Pediatric Orthopaedic Society of North America (POSNA) scores between both groups. The plating group had a significantly worse Manchester scar score than the IM group (P = 0.012). One major complication was observed in each group: osteomyelitis for IM fixation and ulnar never palsy for plating. Conclusion Our study suggests that functional outcome is likely to be equivalent, regardless of which method of internal fixation is used.

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Section: Introductionmentioning

confidence: 99%

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

Teoh

Chee

Shortt

et al. 2009

Journal of Children's Orthopaedics

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“…Distal radial metaphyseal fractures are among the most common fractures seen in children [1,2]. It has been reported that between 35 and 45% of all pediatric fractures involve the radius, with over three-quarters of these involving the distal radius [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Isolated distal radial metaphyseal fractures with an intact ulna: Risk factors for loss of reduction

Sankar

Beck

Brewer

et al. 2011

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to determine the risk factors for loss of reduction in patients with an isolated distal radius fracture and intact ulna. Methods Outpatient records and initial, post-reduction, and follow-up radiographs of children with displaced distal radial metaphyseal fractures and intact ulnas that required closed reduction and casting at our institution were reviewed for demographic factors, body mass index (BMI), initial fracture displacement, residual displacement after reduction, and 3-point cast index. Loss of reduction was defined as angulation C15°in the coronal plane for all ages and/or angulation C20°in the sagittal plane for patients C11 years of age and C30°for children \11 years of age. Additionally, all patients who were remanipulated and/or pinned were considered to have lost reduction. Results Thirty-five of the 76 patients in our series met the criteria for loss of reduction (46%). Multivariate logistic regression revealed that initial angulation in the coronal plane and post-reduction translation in the coronal plane were independent predictors for loss of reduction. Patients with [11°of initial angulation in the coronal plane were 6.3 times as likely to lose reduction (confidence interval [CI]: 1.43-28.3, P = 0.015) and those with any amount of residual translation in the coronal plane after closed reduction were 7.8 times as likely to lose reduction (CI: 2.5-24.0, P \ 0.001). Conclusion Our study, the largest dedicated series of distal radial metaphyseal fractures with intact ulnas, indicates that loss of reduction is common, and that risk factors include initial angulation in the coronal plane and postreduction translation in the coronal plane.

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“…1 To achieve anatomic reduction, surgical management using plates, 2,3 intramedullary rods, 4 and external fixation 5 have been advocated. We evaluated treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Nailing for Diaphyseal Forearm Fractures in Children after Failed Conservative Treatment

Ali

Abdelaziz

El-Lakanney

2010

J Orthop Surg (Hong Kong)

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Purpose. To evaluate treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures. Methods. 11 male and 9 female patients aged 6 to 15 (mean, 12) years underwent intramedullary nailing using Ender nails plus cast immobilisation for fractures of both the radius and ulna after conservative treatment had failed. Results. After a mean follow-up of 24 (range, 12-30) months, results were excellent in 14 patients, good in 5, and fair in one. None was poor. The mean operating time was 36 minutes. The mean time to bone union was 10 (range, 7-12) weeks. The mean time in the cast was 6 (range, 4-11) weeks. The mean time to implant removal was 8 (range, 6-10) months. All patients regained a full range of elbow movement, except in one who had limited supination and pronation (<20º) due to a degree of malrotation. Two patients had pain

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Redisplacement After Closed Reduction of Forearm Fractures in Children

Cited by 26 publications

References 0 publications

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

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

Isolated distal radial metaphyseal fractures with an intact ulna: Risk factors for loss of reduction

Intramedullary Nailing for Diaphyseal Forearm Fractures in Children after Failed Conservative Treatment

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