Refracture of pediatric both-bone diaphyseal forearm fracture following intramedullary fixation with Kirschner wires is likely to occur in the presence of immature radiographic healing

Tsukamoto, Nobuaki; Mae, Takao; Yamashita, Akihisa; Hamada, Takahiro; Miura, T.; Iguchi, Takahiro; Tokunaga, Mikio; Onizuka, Tadashi; Momii, Kenta; Sadashima, Eiji; Nakashima, Yasuharu

doi:10.1007/s00590-020-02689-0

Cited by 9 publications

(26 citation statements)

References 20 publications

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“…Although unclear in four studies, 9/16 refractures occurred with hardware in situ. Data from another study was not able to be categorised by casting time 28 …”

Section: Resultsmentioning

confidence: 99%

“… 28,46 One study reported removal of plates before 12 months increased risk of refracture 34 . One study supported incomplete healing as a risk factor for refracture, 43 while two did not 18,28 . One study reported that residual angulation at consolidation increases refracture risk 43 .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported an insignificant average difference in casting time of 0 and 4 days (no p-value, p = 0.323) between non-refractures and refractures (Table 2). 26,28 Both studies casted for longer than 6 weeks on average. Comparing data from eight eligible studies, 16,17,19,23,24,26,27,37,40 9/290 (3%) fractures that were casted for 6 weeks or less suffered refractures, while 5/48 (10%) that were casted for more than 6 weeks refractured.…”

Section: Surgically Treated Diaphyseal Both-bone Fracturesmentioning

confidence: 99%

“…Data from another study was not able to be categorised by casting time. 28 Non-surgically treated diaphyseal both-bone fractures One study reported an insignificant difference of 1.5 weeks in casting time between non-refractures and refractures (p > 0.05). 18 However, all fractures in the study were casted for longer than 6 weeks.…”

Section: Surgically Treated Diaphyseal Both-bone Fracturesmentioning

confidence: 99%

“…The median average time to refracture was 5 months (range 1 month -8 years). 5,11,12,[18][19][20][21][22][23][25][26][27][28][29][30][31]35,36,[38][39][40][43][44][45]47,48,51,53,54 Only one study documented an average time to refracture greater than 9 months, recording an average of 20 months. 51 This may be because this was a study of unstable fractures.…”

Section: Patient Detailsmentioning

confidence: 99%

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Re‐fractures of the paediatric radius and/or ulna: A systematic review

Bhanushali

Axelby

Patel³

et al. 2021

ANZ Journal of Surgery

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Background: Fractures of the radius and/or ulna are one of the most common injuries in children. Evidence identifying risk factors for refracture, however, has not been summarised in a systematic review. Guidance for counselling patients and parents to minimise the risk of refracture is limited. The aims of this study are to 1) to determine if casting time 6 weeks or less is a risk factor for refracture after paediatric radius and/or ulna fractures, 2) to identify other risk factors for refracture after paediatric radius and/or ulna fractures and 3) to develop more accurate guidelines for counselling parents after a radius and/or ulna fracture in their child. Methods: A thorough search was performed in accordance with the Joanna Briggs Institute (JBI) guidelines for systematic review. JBI Critical Appraisal checklists were used for risk of bias assessment. Results: Diaphyseal both-bone fractures treated non-surgically should be casted for longer than 6 weeks. Surgically treated patients can be casted for less than 6 weeks. Diaphyseal and greenstick fractures have a higher risk of refracture. Residual angulation and incomplete healing in greenstick fractures may lead to a higher risk of refracture. Gender does not affect refracture risk. Falls, use of wheeled vehicles, playground activities and trampolining confer high-risk of refracture. Refracture risk is greatest up to 9 months from initial fracture. Conclusion: Further case-controlled studies with sub-group analysis are required to further investigate risk factors for refracture after radius and/or ulna fractures in children.

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“…Although unclear in four studies, 9/16 refractures occurred with hardware in situ. Data from another study was not able to be categorised by casting time 28 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Surgically Treated Diaphyseal Both-bone Fracturesmentioning

confidence: 99%

Section: Surgically Treated Diaphyseal Both-bone Fracturesmentioning

confidence: 99%

Section: Patient Detailsmentioning

confidence: 99%

See 3 more Smart Citations

Re‐fractures of the paediatric radius and/or ulna: A systematic review

Bhanushali

Axelby

Patel³

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

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Longer time of implantation using the buried pin technique for intramedullary nailing would decrease refracture in the diaphyseal forearm fracture in children-retrospective multicenter (TRON) study

Ohshima

Tokutake

Takegami

et al. 2023

Injury

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Subsequent Forearm Fractures Following Initial Surgical Fixation

Lindgren

Sendek

Manhard

et al. 2023

Journal of Pediatric Orthopaedics

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Introduction: Forearm fractures are a common pediatric injury. Currently, there is no consensus on treatment for fractures that recur following initial surgical fixation. The objective of this study was to investigate the subsequent fracture rate and patterns and describe the treatment of these forearm fractures. Methods: We retrospectively identified patients who underwent surgical treatment for an initial forearm fracture at our institution between 2011 and 2019. Patients were included if they sustained a diaphyseal or metadiaphyseal forearm fracture that was initially treated surgically with a plate and screw construct (plate) or elastic stable intramedullary nail (ESIN), and if they subsequently sustained another fracture that was treated at our institution. Results: A total of 349 forearm fractures were treated surgically with ESIN or a plate fixation. Of these, 24 sustained another fracture, yielding a subsequent fracture rate of 10.9% for the plate cohort and 5.1% for the ESIN cohort (P=0.056). The majority of plate refractures (90%) occurred at the proximal or distal plate edge, while 79% of the fractures treated previously with ESINs occurred at the initial fracture site (P<0.001). Ninety percent of plate refractures required revision surgery, with 50% underwent plate removal and conversion to ESIN, and 40% underwent revision plating. Within the ESIN cohort, 64% were treated nonsurgically, 21% underwent revision ESINs, and 14% underwent revision plating. Tourniquet time for revision surgeries were shorter for the ESIN cohort (46 vs. 92 min; P=0.012). In both cohorts, all revision surgeries had no complications and healed with evidence of radiographic union. However, 9 patients (37.5%) underwent implant removal (3 plates and 6 ESINs) after subsequent fracture healing. Conclusions: This is the first study to characterize subsequent forearm fractures following both ESIN and plate fixation and to describe and compare treatment options. Consistent with the literature, refractures following surgical fixation of pediatric forearm fractures may occur at a rate ranging from 5% to 11%. ESINs are both less invasive at the time of initial surgery and can often be treated nonoperatively if there is a subsequent fracture, while plate refractures are more likely to be treated with a second surgery and have a longer average surgery time. Level of Evidence: Level IV—retrospective case series.

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Refracture of pediatric both-bone diaphyseal forearm fracture following intramedullary fixation with Kirschner wires is likely to occur in the presence of immature radiographic healing

Cited by 9 publications

References 20 publications

Re‐fractures of the paediatric radius and/or ulna: A systematic review

Re‐fractures of the paediatric radius and/or ulna: A systematic review

Longer time of implantation using the buried pin technique for intramedullary nailing would decrease refracture in the diaphyseal forearm fracture in children-retrospective multicenter (TRON) study

Subsequent Forearm Fractures Following Initial Surgical Fixation

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