Single Bone Fixation versus Both Bone Fixation for Pediatric Unstable Forearm Fractures: A Systematic Review and Metaanalysis

Yong, Bicheng; Yuan, Zhe; Li, Jingchun; Li, Yiqiang; Southern, Edward P.; Canavese, Federico; Xu, HongWen

doi:10.4103/ortho.ijortho_125_17

Cited by 9 publications

(9 citation statements)

References 31 publications

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“…Yong et al [ 45 ] state that there is not a significant difference in loss of rotation, union time or complications between single bone and both bone fixation.…”

Section: Surgical Indicationmentioning

confidence: 99%

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

et al. 2020

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Purpose This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option. Methods We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string “forearm fracture AND epidemiology” or “forearm fracture AND diagnosis or “ forearm fracture AND treatment” or “forearm fracture AND casting” or “forearm fracture AND surgery”. Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review. Results Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation. Conclusions There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.

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“…Yong et al [ 45 ] state that there is not a significant difference in loss of rotation, union time or complications between single bone and both bone fixation.…”

Section: Surgical Indicationmentioning

confidence: 99%

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

et al. 2020

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“…Radius and ulna fractures, or both-bone forearm fractures, are the third most common injuries in children [1], and diaphyseal forearm fractures are common injuries that represent between 3 and 6 percent of all paediatric fractures [2]. An important anatomical feature of the forearm is the interosseous membrane, which is a fibrous structure with an oblique orientation from the radius to the ulna [3].…”

Section: Introductionmentioning

confidence: 99%

Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

Khaled

Fadle

Attia

et al. 2021

International Orthopaedics (SICOT)

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Purpose This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures. Methods This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Inclusion criteria were diaphyseal unstable fractures defined as shaft fractures between the distal and proximal metaphyses with an angulation of > 10°, and/or malrotation of > 30°, and/or displacement > 10 mm after attempted closed reduction. Exclusion criteria included open fractures, Galeazzi fractures, Monteggia fractures, radial head fractures, and associated neurovascular injuries. Patients who met the inclusion criteria were randomized to either the single-bone fixation group (intervention) or the both-bone fixation group (control). Primary outcomes were forearm range of motion and fracture union, while secondary outcomes were forearm function (price criteria), radius re-angulation, wrist and elbow range of motion, and surgical time Results A total of 50 children were included. Out of these 50 children, 25 were randomized to either arm of the study. All children in either group received the treatment assigned by randomization. Fifty (100%) children were available for final follow-up at six months post-operatively. The mean age of single-bone and both-bone fixation groups was 11.48 ± 1.93 and 13 ± 1.75 years, respectively, with a statistically significant difference (p = 0.006). There were no statistically significant differences in gender, laterality, affection of the dominant hand, or mode of trauma between single-bone and both-bone fixation groups. All patients in both groups achieved fracture union. There mean radius re-angulation of the single-bone fixation groups was 5.36 ± 4.39 (0–20) degrees, while there was no radius re-angulation in the both-bone fixation group, with a statistically significant difference (p < 0.001). The time to union in the single-bone group was 6.28 ± 1.51 weeks, while the time to union in the both-bone fixation group was 6.64 ± 1.75 weeks, with no statistically significant difference (p = 0.44). There were no infections or refractures in either group. In the single-bone fixation group, 24 (96%) patients have regained their full forearm ROM (loss of ROM < 15°), while only one (4%) patient lost between 15 and 30° of ROM. In the both-bone fixation group, 23 (92%) patients have regained their full forearm ROM (loss of ROM < 15°), while only two (8%) patients lost between 15 and 30° of ROM. There was no statistically significant difference between groups in loss of forearm ROM (p = 0.55). All patients in both groups regained full ROM of their elbow and wrist joints. On price grading, 24 (96%) and 23 (92%) patients who underwent single bone fixation and both-bone fixation scored excellent, respectively. Only one (4%) patient in the single-bone fixation group and two (8%) patients in the both-bone fixation group scored good, with no statistically significant difference in price score between groups (p = 0.49). The majority of the patients from both groups had no pain on the numerical pain scale; 22 (88%) patients in the single-bone fixation group and 21 (84%) patients in the both-bone fixation groups, with no statistically significant difference between groups (p = 0.38). The single-bone fixation group had a significantly shorter mean operative time in comparison to both-bones plating (43.60 ± 6.21 vs. 88.60 ± 10.56 (min); p < 0.001). Conclusion Single-bone ulna open reduction and plate fixation and casting are safe and had a significantly shorter operative time than both-bone fixation. However, single-bone ORIF had a higher risk radius re-angulation, alas clinically acceptable. Both groups had equally excellent functional outcomes, forearm ROM, and union rates with no complications or refractures. Long-term studies are required.

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“…Fixation of just one bone after a fracture of both forearm bones gives satisfactory results. [16][17][18][19] Furthermore, unstable osteosynthesis would cause hypertrophic rather than atrophic type of nonunion. Other possible reasons for nonunion, like the host factors and infection, [12][13][14][15] were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…In this case, intramedullary osteosynthesis with open reduction required minimal deperiostation, if any. Fixation of just one bone after a fracture of both forearm bones gives satisfactory results 16–19. Furthermore, unstable osteosynthesis would cause hypertrophic rather than atrophic type of nonunion.…”

Section: Discussionmentioning

confidence: 99%

Unique case of posttraumatic atrophic proximal ulnar nonunion in a child: a review of the literature with case report

Tudor

Lopac

Tudor

et al. 2022

Current Orthopaedic Practice

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Single Bone Fixation versus Both Bone Fixation for Pediatric Unstable Forearm Fractures: A Systematic Review and Metaanalysis

Cited by 9 publications

References 31 publications

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

Unique case of posttraumatic atrophic proximal ulnar nonunion in a child: a review of the literature with case report

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