Early remodeling in children's forearm fractures

The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all children's fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month: the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10-20 degree angulation in midshaft fractures, and a 20-30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.