Remodeling of Angulated Distal Forearm Fractures in Children

Larsen, Erik Hviid; Vittas, Dimitrios; Torp-Pedersen, S.

doi:10.1097/00003086-198812000-00027

Cited by 49 publications

(33 citation statements)

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“…The specter of treatments ranges from almost never to reduce distal fractures to a very liberal indication for intramedullary nailing in almost all shaft fractures. 51,91,182 Analyzing our practice and outcome in 1998 and seven years forward revealed good results from our indications for reduction, casting and more seldom operative treatment. Acceptable angular corrections in degrees for distal radial fractures at different ages were 15-20 degrees in 4-9 years old, 10-15 degrees in 9-11 years old, 10 degrees in 11-13 years olds and 5 in those older than 13 due to a shorter period of growth before epiphyseal closure.…”

Section: Forearm Fracturesmentioning

confidence: 99%

“…112 • There is greater capacity of remodelling in children, but also of misalignment depending on the number of years of growth left, the location of the fracture (especially the nearness to the growth end of the long bone) and whether the angular deformity is in the plane of movement of the adjacent joint. 51,91 • The epiphyseal plate in children's bone is the weakest point, and consequently a frequent site of fractures in the long bones. The epiphyseal fractures are often classified according to Salter-Harris, dividing the fractures into five subgroups.…”

Section: Why Child Fractures Are Different From Adult Fracturesmentioning

confidence: 99%

“…51,91,129,182,195 Due to the substantial number of these fractures, even arguments involving cost analysis of whether to reduce or not have been used. One study postulated that if distal radial fractures with less than 15 degrees of angulations and less than 1 cm of shortening were not reduced, the emergency room visit would cost 50% less, and the fracture would still completely remodel.…”

Section: Common and Seldom Fractures In Childrenmentioning

confidence: 99%

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Child injuries in Bergen, Norway

Brudvik

2000

Injury

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Section: Forearm Fracturesmentioning

confidence: 99%

Section: Why Child Fractures Are Different From Adult Fracturesmentioning

confidence: 99%

Section: Common and Seldom Fractures In Childrenmentioning

confidence: 99%

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Child injuries in Bergen, Norway

Brudvik

2000

Injury

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“…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.…”

Section: Discussionunclassified

“…Yaş büyüdükçe ve kırık lokalizasyonu proksimale doğru ilerledikçe yeniden şekillenme potansiyeli azalır. 6 14 yaşın üzerindeki önkol kırıklarının erişkin kırığı gibi tedavi edilmesi gerektiğini bildiren birçok çalışma vardır. 2,7,8 Radiusun eğiminin korunması özellikle önemlidir.…”

Section: Discussionunclassified

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

Meriç¹,

Kişin²,

Gem³

et al. 2012

BSBD

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bsbd@balikesir.edu.tr www.bau-sbdergisi.com ÖZET AMAÇ: Önkol kırıklarının tedavisinde en seçkin yöntem kapalı redüksiyon ve alçı tespiti ile uygulanan konservatif tedavidir. Cerrahi gereken önkol çift kırığı tedavisinde kanal-içi titanyum elastik çivi(TEN) yöntemi sıklıkla kullanılmaktadır. Bizde önkol çift kırığı nedeniyle kanal-içi TEN yapılan hastalarımızın tedavi sonuçlarını değerlendirdik. YÖNTEMLER: Çalışmaya, önkol çift kırığı nedeniyle kanal-içi TEN yapılan ve en az 1 yıl süreyle izlenen 23 hasta (2 kız,19 erkek; ort. yaş 12,2;dağılım7-18 yaş) alındı. Hastaların fonksiyonel muayeneleri ve radyolojik takipleri yapıldı. Hastaların fonksiyonel değerlendirmesi Price kriterlerine göre yapıldı. Ortalama takip süresi 20,1(dağılım 12-48ay)aydır. BULGULAR: 23 hastanın 21'inde (%91,3) kaynama gözledik. Kaynamayan 2 hasta konservatif alçı tedavisiyle kaynama elde ettik. Kırıkların ortalama kaynama süresi 2,6 (dağılım 1,5-6 ay) aydır. Dört vakada pin dibi enfeksiyonu( % 17,4)gelişti bu hastalar antibiyoterapi ve debritman ile iyileşti. Üç vakada n.ulnaris duyu dalı felci (% 12,9) gelişti. Ekstensör policis longus (EPL) rüptürü gelişen 1 vakada (%4,3) ekstensör indicis propius tendon transferi ile başparmak ekstansiyonu sağladık. 1 vakada(%4,3) tel malpozisyonu gözlemledik. Fonksiyonel olarak %91,3 (21 vaka) mükemmel sonuç elde ettik. SONUÇ: Fonksiyonel sonuçlarının iyi olması, uygulama tekniğinin ve implant çıkartılmasının kolay olması, daha az yumuşak doku hasarına yol açması nedeniyle çocuk önkol çift kırıklarının cerrahi tedavisinde intramedüller TEN uygulamasının iyi bir seçenek olduğunu düşünüyoruz. Anahtar Kelimeler: çocuk önkol kırıkları, kanal-içi çivi, kemik fiksasyon SUMMARY OBJECTIVE: The treatment of fractures of the forearm between the detection of the most exclusive method of conservative treatment with closed reduction and plaster. Surgical treatment of forearm fractures intramedullary TEN method to be used frequently. We evaluated the treatment results of forearm fractures in patients with intramedullary TEN. METHODS: The study of TEN and intramedullary bone forearm fractures in 23 patients followed for at least 1 year (2 female, 19 male, mean. Age 12.2; range 7-18 years) were included. Functional and radiological follow-up examinations were performed. Price criteria were used for the functional assessment of patients. Median follow-up 20.1 (range 12-48months) months. RESULTS: .21 out of 23 patients (91.3%) observed union. We have two patients with nonunion achieved union with conservative treatment with plaster. Average time to union of fractures 2.6 (range 1.5-6 months) months. Pin-track infection in 4 cases (17.4%) of these patients improved with antibiotherapy and debridement, 3 cases (12.9%) were developed sensory branch of n. ulnaris palsy. 1 case (4.3%) extensor pollicis longus (EPL) rupture in with the thumb extensor indicis propius tendon transfer to provided extension. 1 case (4.3%) wire malposition observed. Functionally, 91.3% (21 cases) have achieved excellent results. CONCLUSION: We thi...

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Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

et al. 2020

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IMPORTANCE Improvement of clinician understanding of acceptable deformity in pediatric distal radius fractures is needed. OBJECTIVE To assess how often children younger than 10 years undergo a potentially unnecessary closed reduction using procedural sedation in the emergency department for distal radial metaphyseal fracture and the associated cost implications for these reduction procedures. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included 258 consecutive children younger than 10 years who presented to a single, level I, pediatric emergency department and who had a distal radius fracture with or without ulna involvement between January 1, 2016, and December 31, 2017. Reductions were deemed to be potentially unnecessary if the coronal and sagittal plane angulation of the radius bone measured less than 20°and shortening measured less than 1 cm on initial injury radiographs. Use of procedural sedation or transfer status to another facility was noted if present. Statistical analysis was performed from April 2019 to June 2019. MAIN OUTCOMES AND MEASURES Potentially unnecessary reduction was the primary outcome. Radiographic findings were measured to determine reduction necessity. Additional variables measured were age, sex, time in the emergency department, transfer status, required reduction procedure, use of sedation, and cost associated with care. RESULTS Of the 258 participants studied, 156 (60%) were male, with a mean (SD) age of 6.7 (2.3) years. Among 142 patients (55%) who underwent closed reduction with procedural sedation in the emergency department, 38 (27%) procedures were determined to be potentially unnecessary. Review of Common Procedural Terminology charges revealed an approximately $7000 difference between the stated cost of a reduction procedure in the emergency department vs a cast application in an outpatient orthopedic clinic for distal radial metaphyseal fractures. The mean (SD) maximal angulation in either plane for fractures that underwent appropriate reduction was 30.6°(10.3°) compared with 13.9°(4.5°) for those unnecessarily reduced (P < .001). Patients who were transfers from other facilities were more than twice as likely to undergo a potentially unnecessary reduction (odds ratio, 2.3; 95% CI, 1.1-5.0; P = .03). CONCLUSIONS AND RELEVANCE The findings suggest that improved awareness of these acceptable deformities in young children may be associated with limiting the number of children requiring reduction with sedation, improving emergency department efficiency, and substantially reducing health care costs.

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Remodeling of Angulated Distal Forearm Fractures in Children

Cited by 49 publications

References 0 publications

Child injuries in Bergen, Norway

Child injuries in Bergen, Norway

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

Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

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