scholarly journals Treatment of Distal Forearm Fractures in Children

2020 ◽  
pp. 145749692098310
Author(s):  
J.-J. Sinikumpu ◽  
Y. Nietosvaara
Keyword(s):  
Case Series ◽  
Distal Forearm ◽  
Articular Fractures ◽  
Fractures In Children ◽  
K Wires ◽  
Metaphyseal Fractures ◽  
Distal Forearm Fractures ◽  
Anatomic Alignment ◽  
Physeal Fractures

Background and Aims: Distal forearm is the most common fracture location in the growing skeleton. The aim of this article is to describe the current practice of these fractures. Materials and Methods: Case series accompanied by experts’ opinion. Results and Conclusion: Most of these injuries are benign incomplete distal metaphyseal torus fractures best treated with a dorsal below elbow splint for 2–3 weeks with no follow-up. Completely displaced metaphyseal fractures in prepubertal children can be either immobilized in bayonet position after axial alignment or fixed with K-wires after reduction. Complete fractures of distal metaphysis in adolescents should heal in near anatomic alignment because remodeling is uncertain. We advocate reduction of most greenstick and complete fractures at the distal metaphyseal diaphyseal junction and radiographic follow-up to monitor fracture alignment. Physeal fractures in adolescents and intra-articular fractures in children of all ages should be anatomically reduced. We perform most of our osteosyntheses with K-wires.

Sokrat II – An International, Prospective, Multicenter, Phase IV Diagnostic Trial to Evaluate the Efficacy of the Wrist SAFE Algorithm in Fracture Sonography of Distal Forearm Fractures in Children

2019 ◽  
Vol 40 (03) ◽  
pp. 349-358 ◽  
Author(s):  
Ole Ackermann ◽  
Piotr Wojciechowski ◽  
Maria Dzierzega ◽  
Kay Grosser ◽  
Ansgar Schmitz-Franken ◽  
...  
Keyword(s):  
Clinical Findings ◽  
X Rays ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Clinical Predictors ◽  
Sonographic Diagnosis ◽  
Fractures In Children ◽  
Study Sites ◽  
Distal Forearm Fractures

Abstract Background Distal forearm fractures are the most common fractures in childhood and can be diagnosed with ultrasound. The aim of this study was to demonstrate the eligibility of Wrist SAFE for clinical use and the avoidance of X-ray application in children. Methods We enrolled patients from 0 – 12 years with suspected distal forearm fractures. They were treated according to the Wrist SAFE algorithm, a detailed pathway for ultrasound fracture diagnosis, treatment decisions and control options. Additionally, 9 clinical predictors were tested. Depending on sonographic and clinical findings, patients were treated with functional movement, immobilization or surgery. Follow-up was conducted after 5 days and 3 months. Results 16 physicians (6 specialists, 10 assistants) at 5 study sites examined 498 (234 boys, 251 girls, 13 not specified) patients with ultrasound, age 8.4 (0 – 12) years. 321 (64 %) patients were diagnosed with a fracture, 5 (0.8 %) with suspected fracture; X-rays were conducted in 58 cases (12 %), 9 (1.8 %) of them on day 1 and 49 (9.8 %) on day 5; sonographic diagnosis was confirmed in 57 of 58 (98 %) cases; in one case, the sonographic diagnosis of “contusion” was revised to “radius fracture”. 381 patients (77 %) underwent final follow-up after an average of 96 (62 – 180) days. All patients were symptom-free at that time. Palpatory bone pain over the radius/ulna and swelling were identified as clinical predictors. 81 % of X-rays were avoided. Conclusion Wrist SAFE enables the safe diagnosis and therapy of distal forearm fractures in children. Findings can be reviewed safely, also enabling physicians in training to use the method. 81 % of X-rays can be avoided, a figure that corresponds to 2.8 million X-rays in the G10 member states. After performing 100 examinations, physician have acquired the necessary sonography skills.

Distal forearm fractures in children: the role of radiographs during follow up

Injury ◽  
1998 ◽  
Vol 29 (4) ◽  
pp. 309-312 ◽  
Author(s):  
J.S. Green ◽  
S.C. Williams ◽  
D. Finlay ◽  
W.M. Harper
Keyword(s):  
Distal Forearm ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Distal Forearm Fractures

X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture

2020 ◽  
Author(s):  
Henrik Johan Sjølander ◽  
Sune Jauffred ◽  
Michael Brix ◽  
Per H. Gundtoft
Keyword(s):  
Diagnostic Imaging ◽  
Forearm Fracture ◽  
Minimal Risk ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Distal Forearm Fracture ◽  
Standard Regimen ◽  
Prolonged Immobilization ◽  
Distal Forearm Fractures

Abstract Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

Bioresorbable  implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures – a retrospective multicentre study

2021 ◽  
Author(s):  
Marcell Varga
Keyword(s):  
Surgical Intervention ◽  
Complication Rates ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Kirschner Wires ◽  
Paediatric Patients ◽  
Fractures In Children ◽  
Significant Difference ◽  
K Wires ◽  
Wire Osteosynthesis

Abstract BackgroundDistal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius and forearm fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.MethodsWe retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5-12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 30 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one year.ResultsThere was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group.ConclusionsSurgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.

Plaster cast treatment for distal forearm fractures in children

2020 ◽  
Vol 29 (2) ◽  
pp. 179-186
Author(s):  
Domenico Ravier ◽  
Ilaria Morelli ◽  
Valentina Buscarino ◽  
Chiara Mattiuz ◽  
Luca M. Sconfienza ◽  
...  
Keyword(s):  
Plaster Cast ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Distal Forearm Fractures

Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

2019 ◽  
Vol 36 (10) ◽  
pp. 613-616 ◽  
Author(s):  
Anniek C Epema ◽  
Mariëlle J B Spanjer ◽  
Lieselotte Ras ◽  
Johannes C Kelder ◽  
Marieke Sanders
Keyword(s):  
The Netherlands ◽  
Diagnostic Accuracy ◽  
Conventional Radiography ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Predictive Values ◽  
Pain Scores ◽  
Fractures In Children ◽  
Distal Forearm Fractures

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

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