Pediatric Both Bone Forearm Fractures: Re-evaluating Unacceptable Alignment and Remodeling Potential in Children up
Olivia Grothaus1, Haley Monson1,2, Jayden Brennan1,2
1Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
Background:
Nonoperative management utilizing closed reduction and immobilization is considered standard of care for pediatric both bone forearm fractures (BBFFs) when alignment meets Noonan and Price criteria (JAAOS 1998). A previous series of patients at our institution revealed a subpopulation who healed outside of these parameters but were asymptomatic.
Methods:
A prospective study of patients with healed fractures at standard 6 to 12-week follow-up with residual sagittal or coronal angulation ≥15° was performed with minimum 2-year follow-up. Patients underwent forearm radiographs, physical examination, and completed PedsQL (Pediatric Quality of Life Inventory). Radiographs at 2 years were compared to those taken at the last standard follow-up to evaluate remodeling. Physical examination was compared between the normal and injured sides and to published norms. PedsQL scores below 1 standard deviation (SD) from the published mean were considered abnormal.
Results:
Forty-eight patients, with initial malunions ≥15° in either plane were identified from 203 eligible patients from 2019 to 2021, and 22 patients (average age: 7.1 years, range: 2.1-11.5) returned for 2-year follow-up. No patients had a residual angulation ≥15°. All patients demonstrated functional range of motion. Five (23%) patients had a ≥10° difference in pronation compared to the uninjured side but showed no significant difference in other outcome or demographic variables compared to those with normal pronation (P > .05). Six (27%) patients scored more than 1 SD below the mean on PedsQL but had no significant differences in other variables or range of motion compared to patients within 1 SD.
Conclusions:
Pediatric BBFFs demonstrated significant remodeling potential without long-term consequences to function or patient-reported outcomes at 2-year follow-up. Although this study has a small population of primarily young patients, it does include 6 patients 9-11 years of age. This may support re-evaluating current recommendations for acceptable alignment of pediatric BBFF in this group.
Key Concepts:
(1)Both bone forearm fractures with ≥15° malunion at 6-8 weeks post injury have the capacity to remodel in patients up to 11 years of age.(2)Significant range-of-motion deficits did not develop in these observed both bone forearm fracture malunions.
Level Of Evidence:
II.
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