Closed Treatment of Displaced Diaphyseal Both-Bone Forearm Fractures in Older Children and Adolescents

Abstract

The management of adolescent radius and ulna diaphyseal fractures is controversial. The purpose of this study was to address the residual deformity and functional outcome following closed treatment of these fractures. Twenty-five older children and adolescents (mean age 13.3 years, range 8.8-15.5) with displaced diaphyseal both-bone forearm fractures underwent closed treatment and were followed for a mean of 49.6 weeks. All fractures united. On the final AP radiograph, the mean angulation was 9 degrees (range 0-18 degrees) for the radius and 8 degrees (0-20 degrees) for the ulna. All patients achieved full elbow and wrist range of motion. Loss of forearm supination and pronation averaged 4 degrees (range 0 to 20 degrees) and 6.8 degrees (0 to 40 degrees), respectively. Closed reduction and casting of displaced both-bone diaphyseal forearm fractures, despite the residual angulation, results in satisfactory functional outcome and should remain a viable treatment option in the management of this injury.

Open Intramedullary Kirschner Wire versus Screw and Plate Fixation for Unstable Forearm Fractures in Children

“…21 In another study, however, all 25 older children (mean age, 13 years; range, 9-16 years) achieved full range of movement of the forearm despite residual angulation. 22 Although treatment modalities and acceptable levels of malalignment remain controversial, there is a consensus that fracture angulation of >10º is not acceptable in patients older than 10 years and requires surgery. 3,5,20,23 Both intramedullary Kirschner wiring and plating are successful treatment modalities 7,8 and have advantages and disadvantages.…”

Untitled

“…Zionst et al 6 , also showed that even with residual angulation the functional result was still satisfactory. Naziri et al 5 also concluded in their study that in children less than 10 years old, angulation of up to 20 degrees was still acceptable.…”

“…Furthermore, the rotational deformity was accepted within 0 to 45 degrees 11 . Creaseman et al 24 , did measure the rotational deformity of the fractures in his study but most other literature measured only the angulation of the fractures 6,7,9,24 . They had difficulty in assessing the rotational deformity in their study due to difficulty in getting true tuberosity view 24 .…”

“…Accepted guidelines for children with more than two years of growth remaining are 15 degrees of angulation 6,15 . There are remaining growth and remodelling in the children after the fracture union as long as the physis is still open.…”

“…This was to ensure that all the selected patients had at least four years of remaining growth before they reached skeletal maturity, which was expected at 14 years old for a girl and 16 years old for a boy 8 . Other studies were assessing majority of their patients within two to three years of follow-up rather than after skeletal maturity [5][6][7]9,10 . In our study however, we were assessing all of our patients after they had reached skeletal maturity.…”