Predictors of conversion from conservative to operative treatment of pediatric forearm fractures

Abstract

Forearm fractures occur commonly in children; however, there is still uncertainty on what leads to conversion from conservative to operative management. Patients who initially underwent closed reduction and casting for diaphyseal forearm fractures were evaluated for predictors of conversion to operative management. We found that the 20 of 124 (16%) patients in whom there was conversion to operative management were significantly older (11.1 vs. 5.7 nonoperative), had less angulation in the anterior-posterior (or coronal) plane (20.2 vs. 12.8° for the radius, 17.5 vs. 7.8° for the ulna), had a more proximal ulnar fracture location, and had more translated or shortened radius fractures.

Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children

“…[2] The standard therapy for stable and only slightly displaced forearm fractures in children is conservative treatment [3,4] However, certain types of forearm fractures require operative treatments such as plate osteosynthesis, pinning by K-wires, or elastic-stable intramedullary nailing (ESIN). [5,6] Based on Küntscher's intramedullary nailing, Jean Prevot and Jean-Paul Metaizeau introduced the ESIN in Nancy (France) in the late 1970 s. [7] Hereby, a nail is inserted in the medullary cavity of the ulna and radius in opposite directions and positioned in the bone under tension to create an arch shape (Fig. 1).…”

The Role of Obesity on Cast Index and Secondary Intervention in Pediatric Forearm Fractures

“…Although there is significant variability in what truly defines loss of reduction in the literature, rates are cited anywhere from 7.3% to 32.3%, which encompasses all variations of pediatric forearm fractures [4,7,16,18,21,[26][27][28][29][30]. In the present study, we defined loss of reduction as any redisplacement that resulted in secondary intervention based on surgeon discretion.…”

“…Predictors of loss of reduction include older age, lack of anatomic reduction immediately postmanipulation magnitude of deformity at the time of fracture, initial magnitude of displacement, more proximal fractures and poor casting technique as evidenced by the cast index, Canterbury index, padding index, or 3-point index [4,16,[26][27][28][29][30]. Furthermore, we chose to evaluate the Cast Index (CI) as it has the advantage of being easy to perform, quick, and reproducible, with concomitantly high inter-and intra-observer reliability [18].…”

Çocuk önkol kırıkları

“…Ancak, brakiyoradyalisin deforme edici etkisinden kurtulmak için supinasyonda olması önerilir. [11] Alçı, uzun kol olacak şekilde ve dirsek 90° fleksiyonda iken uygulanır. Önkolda anterior ve posteriordan bastırılarak, interosseöz aralığın kapanması engellenirken, ulnanın da daha rijid tespitinin devamı sağlanır.…”

“…Redüksiyon sonrası önkolu; kırık hattı proksimalde ise supinasyonda, ortada ise nötral pozisyonda, distalde ise pronasyonda sabitlemek önerilmektedir. [4][5][6][7][8][9][10][11] sonrası oluşan rezidüel açılanma malrotasyona bağlıdır ve manipülasyon esnasında kırığa neden olan kuvvetin karşı yönünde rotasyon uygulanması gereklidir. [4,[7][8]…”