SummaryIntroduction.Forearm fractures make up a significant part of overall fracture rate in pediatric population, especially in 7-15 years old children. Different methods of treatment have been used, depending on the age of children and type and localization of fracture. Most controversies can be seen among conservative and surgical methods of treatment.Aim of the Study.The aim of our study is to identify common localizations and types of forearm bone fractures in pediatric population, as well as analyze patient data and treatment process depending on selected method of treatment for out-patients and in-patients.Materials and Methods.Retrospective analysis of out-patient and in-patient records, treated in University Children’s hospital from 2007 to 2011 was made, including first time patients with fractures of one or both forearm bones, according to ICD-10 codes S52.0- S52.9. Demographical data, trauma mechanisms, localization and type of fracture, as well as applied treatment and stay length at hospital were analyzed. 1742 out-patients and 1029 in-patients, 7-15 years old at the moment of trauma, were included in this research.Results.2771 forearm fractures were registered, 62.9% patients were treated on out-patient basis, 37.1 % patients required treatment in hospital. Forearm bone fractures were gender specific - 2235 boys and 536 girls had to be treated (Male:Female ratio was 4.2 : 1). The peak incidence was seen in 13 years old boys and girls. Boys suffered from forearm fractures more often in any age group. Most common mechanisms of injuries causing forearm fractures in children were related with sports trainings - 22.1%, skiing - 15.0% and traffic injuries - 10.0%. Most common activities at the moment of trauma differ by season - during winter months they include skiing, skating and sledging while in summer falls from height, bicycles and swings are dominant. Several trauma mechanisms, like sport trainings, are not season-dependent. Some injury mechanisms differ significantly by gender. Boys were more often as girls injured during sports trainings and skiing, while girls experience forearm fractures due to bicycling and skating. Occurrence of forearm fractures in children has seasonal differences with two peaks: from June to August and from December to February. Distal forearm fractures are the most often seen localization of overall forearm fractures (42 % in boys and 36 % in girls). In out-patients group conservative treatment was performed - plaster immobilization in 1339 cases and closed reduction, followed by plaster immobilization in 403 cases. In-patients were treated both - conservatively with immobilization in 21 cases and closed reduction in 188 cases, and surgically with K-wire osteosynthesis in 137 cases or elastic stable intramedullary nailing (ESIN) in 683 cases. The type and localization of each fracture, along with the age of patient, are the key factors for choosing the right treatment method. K-wire osteosynthesis was performed in all age groups for unstable fractures in distal or proximal third of forearm. ESIN was a method of choice for unstable or comminuted midshaft fractures of one or both bones, metadiaphyseal fractures and some specific conditions (radial neck fractures, Monteggia fractures-dislocations), especially in older patients. Stay length at hospital was ranging from 1 to 2 hospital days in case of immobilization (mean = 1,05 days), from 1 to 4 days in closed reduction group (mean = 1,32 days), but 1 to 12 days in hospital spent children after K-wire osteosynthesis (mean = 1,99 days) or ESIN (mean = 2,38 days).Conclusions.1. Forearm fractures in children have a significant gender diversity (M : F ratio is 4,2 : 1).2. Peak incidence group is 13 years old adolescents of both genders.3. Seasonality and season-specific injury patterns are typical for pediatric forearm fractures.4. The most common anatomic localization is the distal segment of forearm bones.5. Younger children (7-9 years) are mainly treated by conservative methods, while methods of choice for treatment of forearm fractures in adolescents (13-15 years) are operative.6. Surgical treatment of fractures do not significantly increase stay length at hospital.

Introduction. The overall forearm fracture rate is extremely high in pediatric population, significantly being composed of forearm midshaft fractures. Conservative vs. operative treatment are the two competing approaches being introduced for treatment of these fractures depending on the type and localization of the fracture as well as on the age of children. Objective measurements of ROM and correct interpretation of the results can have a substantial impact on the development of the scientific basis of therapeutic interventions. Aim of the study. 1) to evaluate ROM in elbow and wrist joints using goniometry, comparing conservatively and operatively treated forearm fracture patients with healthy controls; 2) to estimate limitation of ROM that causes subjective complaints; 3) to determine if potential limitations of ROM can be the main argument for choice of treatment method despite the age and gender of the child. Materials and methods. Stratified randomized controlled prospective clinical trial from 2010 to 2012 was performed including comparable groups of conservatively and operatively treated boys and girls (age 7-15 years), 6 months after forearm midshaft fracture, compared to similar groups of children without fractures. Total number of respondents was 180 children (30 in each group). Length of immobilization for all treated children was 4 weeks (28 ± 2 days). None of the included patients was administered to special rehabilitation course. During follow-up active ROM of elbow (flexion, extension, pronation, supination) and wrist (flexion, extension, abduction and adduction) joint was assessed using standard plastic goniometer. All measurements were performed by one person, the same tool, twice for each patient. All children together with parents filled questionnaires about self-estimation of functional status (PedsQL v3.0) before (all groups) and after trauma (treated patients only). Each parent signed informed consent of the participation in the research, hospital’s ethical committee gave the approval for the study. Results. All fractures consolidated. Statistically significant differences were detected comparing both non-operated and operated patients to controls. Both - conservative and operative treatment predicted higher level of ROM limitation rate, compared to controls. Conservative treatment predisposes patients to significantly higher ROM limitation - 75.0 %, compared to operated patients - 31.7%. Most of limitations in all four treated groups were asymptomatic: 77.8 % in conservative groups; 63.2 % in operated groups; and 100 % in controls groups. Subjective complaints of ROM limitations in conservatively treated children were about elbow flexion, elbow pronation and supination and wrist extension. Operated children complained of limited elbow flexion, elbow supination and wrist extension. There were no gender differences amon g conservatively and operatively treated groups, both girls and boys had 53.3 % limitation rate. Dominant hand was injured more often (ratio = 1.14:1). No statistically significant differences were found in all three age groups (7-9 years, 10-12 years and 13-15 years) in both genders, comparing to other age groups of the same gender. Conclusions. The results of this study indicate superior effectiveness of elastic stable intramedullary nailing over conservative approach. Frequency of ROM limitations performing surgical stabilization is more than twice lower than that of conservatively treated children. Only moderate (>200) limitations of ROM cause subjective complaints. Although compensatory capacities of a growing child are high and therefore most limitations of ROM are asymptomatic and do not reduce quality of life, it advocates surgical treatment to become the golden standard for midshaft forearm fracture treatment in pediatric population. The age and gender of a child does not influence frequency and severity of ROM limitations therefore should not be considered as the main arguments while choosing treatment method.