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Systematic Review on the Functional Outcome After Treatment of a Traumatic Bowing Fracture of the Lower Arm in
Linde Musters1, Joost Colaris1
1Resident Orthopaedic Surgery Spaarne Gasthuis, location Hoofddorp, Spaarnepoort 1, 2134 TM Hoofddorp, Netherlands.
Insights
Traumatic bowing in children’s lower arms requires prompt treatment. Reduction and casting effectively restore function, though some pronation loss may occur, highlighting the need to address significant bowing fractures.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Biomechanical Engineering
Background:
- Traumatic bowing of the lower arm is an underdiagnosed condition.
- Inadequate treatment can lead to permanent loss of function.
- Limited information exists on optimal management strategies.
Purpose of the Study:
- To systematically review the treatment effects of traumatic bowing in pediatric lower arms.
- To evaluate the impact of interventions on functional outcomes.
- To identify best practices for managing this condition.
Main Methods:
- Systematic literature search across multiple databases (Embase, Medline, Web of Science, Scopus, Cochrane, PubMed, CINAHL, Google Scholar).
- Inclusion of studies on treatments including reduction, reduction with cast, or cast alone.
- Primary outcome measures focused on function (pronation, supination), post-traumatic function, post-treatment function, and residual bowing.
Main Results:
- Five articles met the inclusion criteria.
- Reduction alone resulted in normal function.
- Reduction followed by casting (4-8 weeks) led to 0-20 degrees of pronation loss.
Conclusions:
- Treatment interventions were generally well-tolerated with direct and rapid functional restoration.
- The degree of bowing acceptable without functional loss remains unclear.
- Reduction is recommended for significant bowing fractures in children with functional limitations due to good outcomes and low complication rates.
Introduction:
Traumatic bowing is a commonly missed diagnosis on which only little information is available, inadequate treatment can cause permanent function loss.
Method:
A systematic review would determine what the effect is of treatment of traumatic bowing of the lower arm in children on the functional outcome. A search on Embase, Medline, Web of Science, Scopus, Cochrane, Pubmed publisher, CINAHL and Google scholar, last accessed at the 15th of May 2016. Intervention of interest was treatment; with reduction, reduction and cast or cast only. The primary outcome measure was (I) function; pro and supination, (II) posttraumatic function, (III) posttreatment function and (IV) residual bowing.
Results:
Five articles were included. Treatment by reduction only showed a normal function, 4 weeks to 8 weeks of cast and reduction followed by cast, both resulted in 0 degrees to 20 degrees residual of pronation loss.
Discussion:
The treatment was overall well tolerated, had a direct effect and lead to faster restore of function. It is unclear to what amount of bowing can be accepted without any loss of function. But in view of the few complications and good results for reduction, the overall opinion is to reduce all significant bowing fractures of the lower arm in children with limited function.
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