[Pediatric forearm fractures. Diagnosis, therapy and possible complications]
Insights
Nonoperative management of pediatric forearm fractures yields excellent outcomes in over 90% of cases. Surgical intervention is reserved for specific complex fractures, with intramedullary rods showing promising results for rotational limitations.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Nonoperative management is the standard for most pediatric forearm fractures.
- Significant limitations in forearm rotation are infrequent with nonoperative treatment.
- Identifying indications for operative intervention is crucial for optimal outcomes.
Purpose of the Study:
- To evaluate the outcomes of nonoperative management for pediatric forearm fractures.
- To identify specific fracture patterns associated with rotational limitations.
- To review indications and methods for operative stabilization.
Main Methods:
- Retrospective review of 102 pediatric forearm fracture cases managed nonoperatively.
- Analysis of fracture location and degree of rotational limitation.
- Review of operative cases managed with elastic intramedullary rods, K-wires, plates, or external fixators.
Main Results:
- Over 90% of children experienced good outcomes with nonoperative management.
- Only 6.1% (6 out of 102) had significant forearm rotation limitation (> 25 degrees).
- Elastic intramedullary rods in 20 children resulted in full range of motion and minimal axial malalignment (< 5 degrees).
Conclusions:
- Nonoperative treatment is highly effective for pediatric forearm fractures.
- Operative stabilization is indicated for specific complex fractures, including open fractures and those with neurovascular involvement.
- Intramedullary devices, particularly elastic rods, are effective for managing rotational deformities.
Abstract:
Nonoperative management of forearm fractures in children has a good outcome in over 90% of all cases. In our own series (n = 102) there were only six children (6.1%) with significant limitation (> 25 degrees) of forearm rotation. In these cases two out of four (50%) were located in the proximal third but only two out of 68 in the distal third. Indications for operative stabilization are the following: compound fractures, fractures associated with vessel and nerve injuries, joint fractures, dislocated fractures of the middle and proximal third, and Monteggia/Galeazzi injuries. As implants intramedullary devices are preferred. Twenty children were managed with elastic IM rods between 1994 and 1995 at our institution. At final follow-up all had a free ROM and a maximal axial malalignment of less than 5 degrees. In the region of the distal forearm K-wires are useful. Plates play a dominant role for corrections and nonunions; external skeletal stabilization is indicated for temporary fixation in compound fractures.
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