The evolution of hand function during remodelling in nonreduced angulated paediatric forearm fractures: a prospective cohort study

Abstract

Forearm fractures are very common orthopaedic injuries in children. Most of these fractures are forgiving due to the unique and excellent remodelling capacity of the juvenile skeleton. However, significant evidence stating the limits of acceptable angulations and taking functional outcome into consideration is scarce. The aim of this study is, therefore, to get a first impression of the remodelling capacity in nonreduced paediatric forearm fractures based on radiological and functional outcome. Children aged 0–14 years with a traumatic angular deformation of the radius or both the radius and ulna, treated conservatively without reduction, were included in this prospective cohort study. Radiographs were taken and functional outcome was assessed at five fixed follow-up appointments throughout a period of one year. Outcome measurements comprised radiographic angular alignment, grip strength and wrist mobility. A total of 26 children (aged 3–13 years) with a traumatic angulation of the forearm were included. Mean dorsal angulation at the time of presentation amounted to 12° (5–18) and diminished after one year to a mean angulation of 4° (0–13). Grip strength, pronation and supination were significantly diminished compared to the unaffected hand up to 6 months after injury. After one year, no significant differences in function between the affected and the unaffected arm were found. Nonreduced angulated paediatric forearm fractures have the potential to remodel in time and have good radiographic and functional outcome one year after trauma, where pronation and grip strength take the longest to recover.

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

“…All of these cases resulted on a successful healing of the fractures and did not require any internal fixation [ 21 ]. Barvelink et al [ 31 ] show good radiographic and functional outcomes in children with forearm fractures nonreduced and treated with only a mean 28 days of cast, at one year of follow-up. Voto et al [ 32 ] demonstrated that 7% of pediatric forearm fractures treated by cast immobilization had reangulation or displacement.…”

Improved forearm rotation even after early conversion to below-elbow cast for non-reduced diaphyseal both-bones forearm fractures in children: a secondary 7.5-year follow up of a randomized trial

“…Furthermore, angulation in the sagittal plane is better tolerated than angulation in the coronal plane, and rotational malunion does not remodel at all [ 22 ]. A recent study by Barvelink et al, published in 2020, showed no association between lower arm fractures with angulation and remaining motion deficit at 1-year follow-up [ 23 ]. Bot et al in 2011 showed that functional impairment after a diaphyseal forearm fracture correlates better with subjective and psychosocial aspects of illness, such as pain and pain catastrophizing, than with objective measurements of impairment (DASH, wrist and elbow function, forearm rotation), radiographic angulation, or grip strength [ 3 ].…”

Is three-point index reliable in the follow-up of the distal radius metaphys fractures in the pediatric age group?

“…It has been demonstrated that non-reduction angled pediatric forearm fractures have the potential to remodel over time, and good radiographic and functional results in terms of grip strength and range of motion after one year [25]. A proper follow-up based on TPI measurements will allow a better treatment with fewer re-displacements and mal-unions.…”