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[Pediatric forearm fractures: indications, technique, and limits of conservative management]
P A Ostermann1, D Richter, K Mecklenburg
1Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliche Kliniken "Bergmannsheil", Bochum.
Insights
Conservative treatment for pediatric forearm fractures is effective and low-risk. Most children achieved excellent functional results, though some proximal fractures impacted forearm rotation.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Conservative management remains a low-risk option for pediatric forearm fractures.
- Minimally invasive surgical techniques are emerging but carry inherent risks for young patients.
Purpose of the Study:
- To evaluate the long-term clinical and radiological outcomes of conservatively treated pediatric forearm fractures.
- To determine the efficacy and potential complications associated with non-operative management.
Main Methods:
- A retrospective clinical and radiological follow-up of 102 pediatric patients with forearm fractures treated conservatively.
- Fracture locations (distal, midshaft, proximal) and types (greenstick, complete, folding) were analyzed.
- Functional outcomes, including range of motion and muscular atrophy, were assessed after an average of 52.4 months.
Main Results:
- 96.1% of patients achieved excellent functional results with a free range of motion.
- One fracture required remanipulation due to redisplacement; all others healed uneventfully.
- Six patients (5.9%) experienced a significant loss of forearm rotation, particularly those with proximal or midshaft fractures.
Conclusions:
- Conservative management is recommended for closed pediatric fractures of the distal and midshaft forearm.
- Operative treatment should be considered for forearm fractures located near the elbow due to potential functional deficits.
Abstract:
Although several "minimal invasive" techniques for the operative management of pediatric forearm fractures have been developed recently, conservative treatment still remains the option with the lowest risk for small patients. We present the results of our clinical and radiological follow-up after an average of 52.4 months (4-112) in 102 pediatric patients. All fractures were treated conservatively. There were 68 fractures (66.7 %) of the distal third of the forearm, 30 fractures (29.4 %) of the midshaft area, and four fractures (3.9 %) in the proximal third of the shaft. Greenstick fractures were seen in 58 cases (56.8 %), complete fractures with displacement of both corticalices in 26 patients (25.5 %), and folding fractures in 18 cases (17.7 %). With the exception of one fracture with the necessity of remanipulation after redisplacement in the cast, all fractures healed uneventfully without any further intervention. Functional results were excellent with a free range of motion of the wrist and elbow and without any signs of muscular atrophy in 96 children (94.1 %) at the time of follow-up. Six patients, however, showed a significant loss of forearm rotation of an average of 25 degrees (15 degrees -50 degrees ). In four of these six patients, the fracture had been situated in the proximal and midshaft area. Thus, two out of four fractures of the proximal forearm (50.0 %) showed a poor functional outcome. On the basis of our data we recommend conservative management for (closed) pediatric fractures of the distal and midshaft area. Operative treatment is indicated in forearm fractures close to the elbow.