Treatment of diaphyseal forearm fractures in children

Abstract

Both bone forearm fractures are common orthopedic injuries. Optimal treatment is dictated not only by fracture characteristics but also patient age. In the pediatric population, acceptable alignment can tolerate greater fracture displacement due to the bone's ability to remodel with remaining growth. Generally, these fractures can be successfully managed with closed reduction and casting, however operative fixation may also be required. The optimal method of fixation has not been clearly established. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation. Plating has advantages of being more familiar to many surgeons, being theoretically superior in the ability to restore radial bow, and providing the possibility of hardware retention. Recently, intramedullary nailing has been gaining popularity due to decreased soft tissue dissection; however, a second operation is needed for hardware removal generally 6 months after the index procedure. Current literature has not established the superiority of one surgical method over the other. The goal of this manuscript is to review the current literature on the treatment of pediatric forearm fractures and provide clinical recommendations for optimal treatment, focusing specifically on children ages 3-10 years old.

Keywords: both-bone fractures; forearm fractures; pediatric; younger children.

Figure 1.

The cast index is sagittal width (B) divided by the coronal width (A). The lines in the figure demonstrate that the measurement is from the inside of the fiberglass.

Figure 2.

Nine year old boy presented with open fracture after fall from a slide. ORIF was performed at the time of initial debridement. A year and a half later patient fell from a bicycle and fractured around his implants. Revision fixation with nails was performed. Recanullation of the bones was necessary to pass nails through the previous area of plating. Removal of nails was performed at 6 months.

Figure 3.

Six year old male who suffered initial fracture after a fall. Initial closed management was successful. Six months after initial injury he fell from a motor scooter and refractured. Intramedullary fixation was elected. Removal at 6 months post operatively is the routine at our institution.