Paediatric forearm refractures- management and outcome: a prospective study

Abstract

<p class="abstract"><strong>Background:</strong> Forearm fractures are one of the commonest injuries accounting for 40% of paediatric fractures with a refracture rate of nearly 5%. Forearm refractures are increasing probably due to poor bone mineralization as a result of decreased physical activity, Vitamin D deficiency. These are treated by conservative measures with closed reduction and casting or by surgical fixation with flexible nails or plates. There are no definitive guidelines for management of forearm refracture and implant removal.</p><p class="abstract"><strong>Methods:</strong> The study is aimed at the epidemiology, methods and difficulties of management and functional outcome of forearm refracture treatment. A prospective study of all the cases of forearm refracture who presented to our institution from 2010 to 2016 with refractures treated either by conservative methods or by IMN. All cases were followed up for 2 years and functional outcome was assessed serially according to price et-al criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study contained 17 males and 8 females between 6 years and 14 years. 76% refractures occurred before 16 weeks and majority had only tricortical union at this time. 42% patients underwent surgical fixation following refracture. Price et al criteria showed excellent results in 72% of patients.</p><p class="abstract"><strong>Conclusions:</strong> Forearm refractures in children can be treated both conservatively and surgically like a primary fracture depending on the indications but needs 2 to 3 more weeks of immobilization. A good functional outcome was obtained in majority of the cases. We suggest using splints till quadricortical union is achieved to prevent chances of refracture.</p>

Management of isolated distal end of radius fracture in pediatric age group: An observational study

“…In a similar study comprising of 32 patients Kuloor SB et al, found that 56% of the patients had union at 6 weeks and all patients had union at 8 weeks follow up visit. These findings were similar to the findings of our study 18. Finally in our study functional outcome as assessed on the basis of Quick DASH score showed that 42 (70%) patients had excellent functional outcome whereas 9 (15%) patients had good functional outcome.…”

How common are refractures in childhood?

“…There are studies that have focused solely on the risk of refracture in the forearm, which the current study demonstrates to be the segment most commonly affected by refractures. 4,7,11,15 Bould and Bannister 7 reported a rate of 4.9% refractures in a study of 768 children with forearm fractures, while Kuloor et al 11 reported similar findings of a refracture rate of 4.7% in 610 forearm fractures. In 2021, Soumekh et al 15 studied refracture rates in 426 diaphyseal forearm fractures with different immobilization regimens, and found that they were 1.7% to 5%.…”

“…Although many studies have described the epidemiology of paediatric fractures, only a few have examined the incidence of refractures. 2,[6][7][8][9][10][11][12][13][14][15][16] These studies of refractures in children are retrospectively reviewed cohorts of a specific part of the body, most commonly focusing on the forearm. [7][8][9][10][11][12][13][14][15] To the best of our knowledge, no previous study has described refractures in relation to all occurring primary fractures.…”

“…2,[6][7][8][9][10][11][12][13][14][15][16] These studies of refractures in children are retrospectively reviewed cohorts of a specific part of the body, most commonly focusing on the forearm. [7][8][9][10][11][12][13][14][15] To the best of our knowledge, no previous study has described refractures in relation to all occurring primary fractures. For this reason, the questions of how common refractures are and when they occur in relation to the primary fracture have not been fully clarified.…”