Risk of Refracture in Proximal Both Bone Forearm Fractures in Children

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Pediatric trauma

Background:

• Pediatric patients with proximal both bone forearm fractures face a notable risk of refracture.
• The study investigates the association between initial treatment strategies and increasing volar angulation of the radius with refracture risk.

Purpose of the Study:

• To evaluate if initial treatment strategy and increasing volar angulation of the radius are linked to a higher need for rereduction or refracture in pediatric forearm fractures.

Main Methods:

• A retrospective review of medical records for skeletally immature patients with proximal one-third radius and associated ulna fractures.
• Statistical analysis included Fisher exact test, t-test, and logistic regression to assess refracture risk factors.
• Exclusion criteria included inadequate follow-up, single-bone fractures, or other fracture types.

Main Results:

• Out of 147 patients, 10.2% experienced refractures; 20.4% required additional treatment.
• Initial management strategies (splinting, casting, surgical intervention) showed no association with refracture risk.
• Increased volar angulation of the radius at follow-up (mean 6 weeks) was significantly higher in refracture cases (15.8° vs 6.9°, P = 0.0039).

Conclusions:

• Increasing volar angulation of the radius at union is a strong predictor of refracture risk in pediatric forearm fractures.
• Initial treatment strategy did not influence the risk of refracture.
• A volar angulation cutoff of less than 10° is recommended for nonsurgical management of pediatric radius fractures.