Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures

Diaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients.

A retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed.

We found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04).

Radial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.