Factors that predict instability in pediatric diaphyseal both-bone forearm fractures

Kutsikovich, Jeffrey I.; Hopkins, Chris; Gannon, Edwin; Beaty, James H.; Warner, William C.; Sawyer, Jeffrey R.; Spence, David D.; Kelly, Derek M.

doi:10.1097/bpb.0000000000000480

Cited by 19 publications

(15 citation statements)

References 26 publications

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“…Based on a retrospective assessment of 174 children with forearm bone fractures, Kutsikovich et al, they selected the most likely prognostic factors for the secondary instability of bone fragments after an operative treatment. These are: translation of bone fragments more than 50% in each plane, the patient's age above 9 y.o., complete radial fracture, and angulation of the radius > 15° on lateral radiographs and of the ulna >10° on AP radiographs [13]. A similar analysis was carried out by Arora et al who evaluated 113 patients [8].…”

Section: Discussionmentioning

confidence: 83%

Comparison of complications of the treatment of diaphyseal forearm fractures in children with respect to the treatment method

Wilczyński¹,

Ciszewski²,

Matuszewski³

2020

Chir. Narzadow Ruchu Ortop. Pol.

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Introduction. Forearm fractures are the second most common injuries to the locomotor system in children, after injuries to the distal forearm. Usually, pediatric forearm fractures occur due to indirect violence. In the treatment of forearm fractures in children, we aim to achieve union, correct length and axis of both forearm bones. Forearm fractures can be treated non-operatively, with casting, as well as operatively. In children, the most commonly used operative method is closed reduction and intramedullary stabilization using TENs. We cannot forget about complications during treatment. Aim. The aim of the study is to analyze the most common late complications of diaphyseal fractures of both forearm bones in children in relation to the treatment method. Material and methods. The study included 120 children aged 3-17 y.o., hospitalized in the Pediatric Orthopedics and Rehabilitation Clinic at the Medical University in Lublin in 2014-2018. The children were divided into 2 groups based on the type of diaphyseal forearm fractures. The analysis included the type and frequency of complications with regard to the treatment method. Results. The study groups consisted of 57 patients treated non-operatively-with casting and 63 patients treated operatively with flexible intramedullary nails. 24 girls and 33 boys were treated non-operatively. 13 girls and 50 boys were treated operatively. Among 61 patients treated non-operatively, 45 had no complications, 14 developed refractures, 1 had a delayed union, and 1 patient had a non-union. Among 59 patients treated operatively, 53 had no complications, 5 developed refractures, and 1 had a delayed union. The most common complication in both modalities was refracture. The complications of non-operative treatment were managed non-operatively in 10 patients and operatively in 4 patients. Operative treatment complications in 1 patient were managed non-operatively while 6 required repeat intramedullary fixation. Any form of treatment complications developed in every fourth patient who received non-operative treatment, while in the case of flexible intramedullary fixation, in every tenth patient. Conclusions. The method of management did not significantly influence the frequency of a specific complication. These complications were 2.5 times more frequent in non-operative treatment, compared to the operative method.

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Section: Discussionmentioning

confidence: 83%

Comparison of complications of the treatment of diaphyseal forearm fractures in children with respect to the treatment method

Wilczyński¹,

Ciszewski²,

Matuszewski³

2020

Chir. Narzadow Ruchu Ortop. Pol.

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“…Furthermore, there is limited remodeling in the forearm diaphysis, which is far from the metabolically active growth plates. Malunited fractures tend to be associated with decreased forearm rotation, resulting in a more aggressive approach with surgical stabilization often being required (Kutsikovich et al 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Malunited fractures tend to be associated with decreased forearm rotation, resulting in a more aggressive approach with surgical stabilization often being required (Kutsikovich et al. 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Determining the development stage of the ossification centers around the elbow may aid in deciding whether to use ESIN or not in adolescents’ forearm shaft fractures

et al. 2021

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“…A, white box illustrating metaphysis; from radial tuberosity to metaphysis, backbone regarded as backbone; backbone divided into three equal parts, followed by proximal, middle, and distal segments; B, in lateral radiograph, CD considered perpendicular to the epiphyseal plate of distal radius; angle between AB and CD considered the angle of radius fracture; angle between EF and GH considered the angle of ulna fracture; in the orthographic film, KL considered perpendicular to the epiphyseal plate of the distal radius, and angle between IJ and KL considered -3.7°(i.e., the angle of radius fracture). (15,(22)(23)(24), and consider that the failure rate of closed reduction in children over 10 years is high and the acceptable angle range is small. Finally, this study limited the age of children to 6 -9 years, thereby reducing the effect of age on fracture shaping.…”

Section: Discussionmentioning

confidence: 99%

Risk Analysis of Re-displacement After Conservative Treatment of Pediatric Unstable Fractures of Middle and Distal Forearm

Xu¹,

Qin²,

Wang³

et al. 2021

Iran J Pediatr

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Background: Fractures of the middle and distal diaphysis of the forearm are common in children. Conservative treatment is effective in this regard. Some studies have discussed the risk factors and predictive indicators of re-displacement; however, the objects of the study are all fixed with tubular plaster or double sugar splint. Objectives: This study was performed to determine the risk factors of re-displacement after closed reduction and double splint plaster fixation of unstable pediatric fractures of the middle and distal diaphysis of the forearm. Methods: This retrospective study was conducted on 57 patients undergoing closed reduction and plaster fixation after unstable diaphyseal fractures of the middle and distal forearm in Wuxi Children's Hospital of Nanjing Medical University within May 2014 to May 2020. A total of 35 male and 22 female subjects aged 6 - 9 years (average: 7.3 years) participated in this study. They were followed up for more than 6 weeks after fracture healing. According to whether experiencing a secondary displacement within 2 weeks after the fracture, the subjects were divided into two groups, namely displacement, and non-displacement. Gender, age, double fracture, reduction quality, and plaster fixation type were analyzed as relevant, effective factors. Results: All 57 patients were followed up, and all fractures reached clinical healing standards at the last follow-up. Moreover, 20 and 37 cases were in the shift and non-shift groups, respectively. No statistically significant difference was reported in gender (c2 = 0.168; P = 0.780), age (t = 1.003; P = 0.217), double fracture (c2 = 0.021; P = 1), and plaster fixation type (c2 = 0.416; P = 0.699) between the two groups. The reduction quality (c2 = 7.480; P = 0.025) showed a statistically significant difference. Binary logistic regression analysis showed that reduction quality was a risk factor for fracture relocation providing a predictive value. Conclusions: Good reduction quality can reduce the risk of fracture displacement.

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Factors that predict instability in pediatric diaphyseal both-bone forearm fractures

Cited by 19 publications

References 26 publications

Comparison of complications of the treatment of diaphyseal forearm fractures in children with respect to the treatment method

Comparison of complications of the treatment of diaphyseal forearm fractures in children with respect to the treatment method

Determining the development stage of the ossification centers around the elbow may aid in deciding whether to use ESIN or not in adolescents’ forearm shaft fractures

Risk Analysis of Re-displacement After Conservative Treatment of Pediatric Unstable Fractures of Middle and Distal Forearm

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