The shaft fractures of the radius and ulna in children

Abstract

The incidence of forearm shaft fractures in children has increased in recent years. They are challenging to treat and they can result in several long-lasting complications. The treatment of children's fractures needs to be individualized to their needs. Nonoperative care will be satisfactory for young, preschool children and it is primarily treatment in stable fractures of children at every age. Injury mechanism must be understood to perform appropriate closed reduction. Immobilization using a long-arm cast needs to be focused against the deforming muscle forces - in particular those that rotate - in the forearm, keeping the bones in alignment until bone healing. Operative stabilization by elastic stable intramedullary nailing is the primarily method of treatment in cases of unstable fractures, in particular, in children between preschool age and adolescence. For older children near to skeletal maturity, a rigid plate and screw fixation will be justified. The most common complication after closed treatment is worsening of the alignment and need for repetitive interventions. elastic stable intramedullary nailing results usually in good outcome, and range of forearm rotation is the main feature determining the clinical result. In this article, we report the current concept of paediatric shaft fractures in the radius and ulna.

Predictive factors for re-displacement in diaphyseal forearm fractures in children—role of radiographic indices

“…The majority of these fractures are successfully treated non-operatively by manipulative reduction and cast immobilization (Vopat et al. 2014, Sinikumpu and Serlo 2015). …”

“…Refractures occur more frequently after forearm shaft fracture than after other fractures in children, with an incidence of approximately 6–10% (Lascombes et al. 2006, Sinikumpu and Serlo 2015). …”

The titanium elastic nail serves as an alternative treatment for adult proximal radial shaft fractures: a cohort study

“…Generally, TENs are popularly applied to pediatric fractures due to the thick periosteum and the increased potential for bone remodeling in children, but they are not routinely used in adults because of lack of resistance to rotational force and axial loading [ 7 , 8 ]. However, TENs are appropriate for the stabilization of proximal forearm fractures, which spares the massive soft tissue dissection and avoids the possibility of PIN injury.…”

“…It is worth noting that the precontoured elastic stable intramedullary nail (such as titanium elastic nail (TEN) fixation for radial shaft fractures) is widely used in children as it is safer and more efficient compared with plating [ 6 ]. This technique preserves the periosteum, allowing bone healing within a closed and intact biological environment [ 7 , 8 ]. By contrast, adult bone healing properties are diminished compared with that of children.…”

Epidemiology of Forearm Fractures in the Population of Children and Adolescents: Current Data from the Typical Polish City

“…In the light of the published data, there are no clearly documented reasons or etiopathogenetic links to the bone fragility in the first two decades of life, as some fractures in children and adolescents result from many coexisting factors such as age, race, biogeographic conditions, sex (predominance of boys), some physiological and environmental factors, lifestyle or even familial and genetic factors. A clear cause of fractures in low-energy trauma has not yet been established [25][26][27]. The forearm fractures caused by the direct trauma are often related to the hormonal changes during puberty.…”