A 5-year Overview of Forearm Fracture Etiology and Treatment Options in 7-15 Years Old Children

SummaryIntroduction.Forearm fractures make up a significant part of overall fracture rate in pediatric population, especially in 7-15 years old children. Different methods of treatment have been used, depending on the age of children and type and localization of fracture. Most controversies can be seen among conservative and surgical methods of treatment.Aim of the Study.The aim of our study is to identify common localizations and types of forearm bone fractures in pediatric population, as well as analyze patient data and treatment process depending on selected method of treatment for out-patients and in-patients.Materials and Methods.Retrospective analysis of out-patient and in-patient records, treated in University Children’s hospital from 2007 to 2011 was made, including first time patients with fractures of one or both forearm bones, according to ICD-10 codes S52.0- S52.9. Demographical data, trauma mechanisms, localization and type of fracture, as well as applied treatment and stay length at hospital were analyzed. 1742 out-patients and 1029 in-patients, 7-15 years old at the moment of trauma, were included in this research.Results.2771 forearm fractures were registered, 62.9% patients were treated on out-patient basis, 37.1 % patients required treatment in hospital. Forearm bone fractures were gender specific - 2235 boys and 536 girls had to be treated (Male:Female ratio was 4.2 : 1). The peak incidence was seen in 13 years old boys and girls. Boys suffered from forearm fractures more often in any age group. Most common mechanisms of injuries causing forearm fractures in children were related with sports trainings - 22.1%, skiing - 15.0% and traffic injuries - 10.0%. Most common activities at the moment of trauma differ by season - during winter months they include skiing, skating and sledging while in summer falls from height, bicycles and swings are dominant. Several trauma mechanisms, like sport trainings, are not season-dependent. Some injury mechanisms differ significantly by gender. Boys were more often as girls injured during sports trainings and skiing, while girls experience forearm fractures due to bicycling and skating. Occurrence of forearm fractures in children has seasonal differences with two peaks: from June to August and from December to February. Distal forearm fractures are the most often seen localization of overall forearm fractures (42 % in boys and 36 % in girls). In out-patients group conservative treatment was performed - plaster immobilization in 1339 cases and closed reduction, followed by plaster immobilization in 403 cases. In-patients were treated both - conservatively with immobilization in 21 cases and closed reduction in 188 cases, and surgically with K-wire osteosynthesis in 137 cases or elastic stable intramedullary nailing (ESIN) in 683 cases. The type and localization of each fracture, along with the age of patient, are the key factors for choosing the right treatment method. K-wire osteosynthesis was performed in all age groups for unstable fractures in distal or proximal third of forearm. ESIN was a method of choice for unstable or comminuted midshaft fractures of one or both bones, metadiaphyseal fractures and some specific conditions (radial neck fractures, Monteggia fractures-dislocations), especially in older patients. Stay length at hospital was ranging from 1 to 2 hospital days in case of immobilization (mean = 1,05 days), from 1 to 4 days in closed reduction group (mean = 1,32 days), but 1 to 12 days in hospital spent children after K-wire osteosynthesis (mean = 1,99 days) or ESIN (mean = 2,38 days).Conclusions.1. Forearm fractures in children have a significant gender diversity (M : F ratio is 4,2 : 1).2. Peak incidence group is 13 years old adolescents of both genders.3. Seasonality and season-specific injury patterns are typical for pediatric forearm fractures.4. The most common anatomic localization is the distal segment of forearm bones.5. Younger children (7-9 years) are mainly treated by conservative methods, while methods of choice for treatment of forearm fractures in adolescents (13-15 years) are operative.6. Surgical treatment of fractures do not significantly increase stay length at hospital.

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Can intraoperative ultrasound visualize the closed reduction and elastic intramedullary nail fixation processes of double forearm fractures in children?

Medicine ◽

10.1097/md.0000000000024324 ◽

2021 ◽

Vol 100 (12) ◽

pp. e24324

Author(s):

Xiaodong Yang ◽

Lang Li ◽

Xueyang Tang ◽

Bo Xiang ◽

Tianfu Wen

Keyword(s):

Intramedullary Nail ◽

Closed Reduction ◽

Intraoperative Ultrasound ◽

Forearm Fractures ◽

Fractures In Children

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

10.21203/rs.3.rs-1137765/v1 ◽

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.

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Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Medicina ◽

10.3390/medicina56020079 ◽

2020 ◽

Vol 56 (2) ◽

pp. 79

Author(s):

Ovidiu Adam ◽

Vlad Laurentiu David ◽

Florin George Horhat ◽

Eugen Sorin Boia

Keyword(s):

Closed Reduction ◽

Diagnosis Related Groups ◽

Financial Burden ◽

Treatment Options ◽

Indirect Costs ◽

Forearm Fractures ◽

Titanium Elastic Nail ◽

Fractures In Children ◽

Elastic Nail ◽

The Cost

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

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Redisplacement After Closed Reduction of Forearm Fractures in Children

Journal of Pediatric Orthopaedics ◽

10.1097/01241398-199010010-00015 ◽

1990 ◽

Vol 10 (1) ◽

pp. 79-84 ◽

Cited By ~ 1

Author(s):

Stephen J. Voto ◽

Dennis S. Weiner ◽

Bonnie Leighley

Keyword(s):

Closed Reduction ◽

Forearm Fractures ◽

Fractures In Children

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A study on conservative management on paediatric bone forearm fractures in tertiary care hospital in Cuddalore district

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194827 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1186

Author(s):

Manikandarajan . ◽

Dinesh Raj

Keyword(s):

Conservative Management ◽

Medical Records ◽

Closed Reduction ◽

Pediatric Population ◽

Tertiary Care ◽

Plaster Cast ◽

Final Visit ◽

Care Hospital ◽

Forearm Fractures ◽

Before And After

Background: Diaphyseal fractures of the radius and ulna are common in the pediatric population. The standard management for pediatric forearm fractures remains conservative management with closed reduction and immobilization with an above elbow plaster cast. Though the fracture unites readily, malunion is very common. Stiffness of joints, compartment syndrome is other complications of conservative management with plaster cast Forearm fractures are common in the pediatric population. These fractures are mostly managed conservatively by means of closed manual reduction and casting. The aim of this study was to reiterate the importance of conservative management in both bone forearm fractures in the pediatric population.Methods: This was a prospective study from a tertiary level trauma center on 70 children up to 14 years of age with both bone forearm fractures from June 2018 to June 2019, cases were obtained from medical records. Data were collected and confirmed by plain X-ray films and medical records.Results: All fractures achieved union at the final visit. More than 90 of diaphyseal forearm fractures achieved exceptional radiological and clinical outcomes and almost no case had a significantly poor outcome. There were significantly reduced angulation deformities before and after treatment (p<0.05).Conclusions: Nonsurgical treatment as a model of management by means of closed reduction and casting is a very well accepted method of treating pediatric diaphyseal forearm fractures.

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Ulnar Nerve Injury Following Midshaft Forearm Fractures in Children

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80449-4 ◽

1997 ◽

Vol 22 (6) ◽

pp. 788-789 ◽

Cited By ~ 20

Author(s):

S. STAHL ◽

N. ROZEN ◽

M. MICHAELSON

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Scar Tissue ◽

Full Recovery ◽

Forearm Fractures ◽

Fractures In Children ◽

Forearm Bones ◽

Early Exploration ◽

Closed Fractures ◽

Ulnar Nerve Injury

We report three cases of ulnar nerve deficit in children following closed fractures of the forearm bones. Significant anterior angulation and displacement of the ulna was noted in all patients. Two patients were operated on at a later stage when no evidence of recovery was demonstrated; the ulnar nerve was found to be embedded in dense scar tissue. One patient was operated on at the time of injury; entrapment of the nerve on the anterior spike and partial transection was found. Early exploration is indicated in such cases and may result in full recovery.

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Nonunion of a Distal Radial Fracture in a Healthy Child

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80056-3 ◽

1997 ◽

Vol 22 (2) ◽

pp. 175-177 ◽

Cited By ~ 17

Author(s):

S. KWA ◽

M. A. TONKIN

Keyword(s):

Healthy Child ◽

Closed Reduction ◽

Distal Radial Fracture ◽

Radial Fracture ◽

Distal Radial Fractures ◽

Fractures In Children ◽

Plaster Immobilization

Nonunion of distal radial fractures in children are rare. We report a case of a closed distal radial fracture in a healthy child, which developed a nonunion following closed reduction and plaster immobilization.

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Functional outcome of elastic intramedullary nailing of forearm fractures in children using pin leverage technique

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192680 ◽

2019 ◽

Vol 5 (4) ◽

pp. 661

Author(s):

Alamgir Jhan ◽

Wazir Fahad Jan ◽

Ganesh Singh Dharamshaktu ◽

Tajinder Bhalla ◽

Saika Rasool ◽

...

Keyword(s):

Functional Outcome ◽

Intramedullary Nailing ◽

Closed Reduction ◽

Tertiary Care ◽

Plaster Cast ◽

Forearm Fractures ◽

Tertiary Care Centre ◽

Fractures In Children ◽

Diaphyseal Fractures ◽

Elastic Intramedullary Nailing

Background: There is a recent trend towards elastic intramedullary nailing in fixation of pediatric forearm bone diaphyseal fractures. But in children we should always attempt closed reduction and immobilsation in a moulded plaster cast. Irreducible, open fractures and those that get redisplaced in moulded plaster cast need operative fixation with intramedullary nailing. Our aim was to know the outcome of tens nailing in such fractures.Methods: We studied functional and radiological outcome of elastic intramedullary nailing by pin leverage technique in forearm fractures in 34 children. The study was done at a tertiary care centre in Uttrakhand, India from May, 2016 to July, 2018. Inclusion criteria were closed forearm fractures; diaphyseal fractures; age 1 to 19 years. Exclusion criteria were open type 2 and type 3 Gustillo-Anderson fractures; metaphyseal, epiphyseal forearm fractures; age >19 years; pathological fractures.Results: Closed reduction and percutaneous pin leverage technique for reduction was successful in all but 4 patients where limited open reduction was used for reduction of fracture fragments. All fractures united radiologically between 7 to 13 weeks with mean distribution of 9.2 weeks. For functional outcome we used modified Price and Daruwala’s score. 28 patients showed excellent results and 6 patients showed good results. All our patients had radiological union in mean of 9.2 weeks (7-13 weeks).Conclusions: Fixation with intramedullary TENS nailing is an effective and affordable way of treating patients in paediatric age group.

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Treatment of diaphyseal forearm fractures in children

Orthopedic Reviews ◽

10.4081/or.2014.5325 ◽

2014 ◽

Vol 6 (2) ◽

Cited By ~ 9

Author(s):

Matthew L. Vopat ◽

Patrick M. Kane ◽

Melissa A. Christino ◽

Jeremy Truntzer ◽

Philip McClure ◽

...

Keyword(s):

Current Literature ◽

Open Reduction ◽

Pediatric Population ◽

Plate Fixation ◽

Optimal Treatment ◽

Forearm Fractures ◽

Optimal Method ◽

Fractures In Children ◽

Soft Tissue Dissection ◽

Orthopedic Injuries

Both bone forearm fractures are common orthopedic injuries. Optimal treatment is dictated not only by fracture characteristics but also patient age. In the pediatric population, acceptable alignment can tolerate greater fracture displacement due to the bone’s ability to remodel with remaining growth. Generally, these fractures can be successfully managed with closed reduction and casting, however operative fixation may also be required. The optimal method of fixation has not been clearly established. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation. Plating has advantages of being more familiar to many surgeons, being theoretically superior in the ability to restore radial bow, and providing the possibility of hardware retention. Recently, intramedullary nailing has been gaining popularity due to decreased soft tissue dissection; however, a second operation is needed for hardware removal generally 6 months after the index procedure. Current literature has not established the superiority of one surgical method over the other. The goal of this manuscript is to review the current literature on the treatment of pediatric forearm fractures and provide clinical recommendations for optimal treatment, focusing specifically on children ages 3-10 years old.

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Pediatric forearm fractures with tens: freedom of movements

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162841 ◽

2016 ◽

Vol 2 (3) ◽

pp. 142

Author(s):

Shivanna Shivanna ◽

Maruthi C. V.

Keyword(s):

Range Of Motion ◽

Bone Fractures ◽

Case Series ◽

Open Fractures ◽

Forearm Fractures ◽

Titanium Elastic Nailing ◽

Fractures In Children ◽

Elastic Nails ◽

Both Bones ◽

Single Bone

Background: A prospective analysis of a case series of diaphyseal forearm fractures in children treated with titanium elastic nails is presented. Methods: Between 2012 and 2014, 30 children aged 5-15 years with displaced diaphyseal forearm fractures underwent titanium elastic nailing. Both bones were fractured in 25 patients, four fractured only the radius, and one experienced ulna fracture. Eleven candidates had unstable irreducible fractures, 13 had loss of reduction, and six had open fractures. Titanium elastic nails were used to stabilize the fractures. All fractures were immobilized postoperatively with an above-elbow plaster slab for 2 weeks till the swelling is completely resolved followed by encouraging range of motion exercises.Results: Closed reduction and TENS was successful in 20 cases, including 15 double-bone fractures and five single-bone fractures. Open reduction was completed in four fractures of both bones, and in six single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. The ROM of the forearms was evaluated using the Daruwalla grading criteria. Excellent results were reported in 96% without significant complications after a mean follow-up of 20 months.Conclusions: Titanium elastic nails fixation of pediatric forearm fractures revealed several advantages, a small incision for insertion, a low rate of complications, unhindered bone healing, and good clinical and radiological results thus achieving maximum range of motion at the earliest.

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