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

Abstract

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.

Keywords: Casts; Conservative treatment; Forearm; Fractures; Pediatric; Surgery; Trauma.

Fig. 1

Anatomy of the forearm with the insertion point of the main muscles

Fig. 2

The correct procedure to make a forearm cast is illustrated. Cast is molded with anterior and posterior pressure applied over the intraosseous membrane. Medial and lateral molding above the humeral condyles will prevent distal sliding of the cast

Fig. 3

These illustrations show the different stages of conservative management of pediatric both-bone forearm fractures: AP and lateral radiographic projections of the fracture at the time of diagnosis (up), AP and lateral projections after forearm plaster cast (middle), AP and lateral projections after cast removal (down)

Fig. 4

AP and lateral radiographic projection of both-bone forearm fractures treated with double elastic intramedullary nails technique

Fig. 5

AP and lateral radiographic projection of both-bone forearm fractures treated with single elastic intramedullary nail technique

Fig. 6

AP and lateral radiographic projections of post-operative treatment of a bi-osseous forearm fractures with two plates

Fig. 7

Flowchart treatment proposal, based on the available data in literature