Subsequent Forearm Fractures Following Initial Surgical Fixation.

Area of Science:

• Pediatric Orthopedics
• Trauma Surgery
• Biomedical Engineering

Background:

• Forearm fractures are common pediatric injuries.
• No established consensus exists for treating recurrent fractures after initial surgical fixation.
• This study addresses the need for understanding subsequent fracture patterns and treatments.

Purpose of the Study:

• To investigate the rate and patterns of subsequent forearm fractures after surgical fixation.
• To describe and compare treatment options for these refractures.
• To evaluate the outcomes of different fixation methods (plate vs. ESIN).

Main Methods:

• Retrospective review of pediatric patients with forearm fractures (2011-2019).
• Inclusion criteria: diaphyseal/metadiaphyseal fractures, initial surgical fixation with plate/screws or elastic stable intramedullary nail (ESIN).
• Analysis of subsequent fracture rates, patterns, and treatments.

Main Results:

• A total of 349 fractures were analyzed; 24 sustained subsequent fractures.
• Subsequent fracture rate was 10.9% for plate fixation and 5.1% for ESIN (P=0.056).
• Plate refractures often occurred at plate edges (90%), requiring revision surgery (90%); ESIN refractures occurred at the initial site (79%) and were often treated nonoperatively (64%).

Conclusions:

• This study is the first to compare subsequent fractures after ESIN and plate fixation.
• Refracture rates range from 5% to 11%, consistent with literature.
• ESINs offer less invasive initial surgery and more nonoperative options for refractures compared to plate fixation.