Nonreduced angulated pediatric forearm fractures yielded good outcomes 1-year post-injury
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Published results showed nonreduced angulated pediatric forearm fractures may remodel over time with good radiographic and functional outcomes 1 year post-injury.
Britt Barvelink, MD, Joris J.W. Ploegmakers, MD, and colleagues assessed radiographs and functional outcomes of 26 children with traumatic angular deformation of the radius or both the radius and ulna treated without reduction at 1, 4 and 6 weeks and 6 and 12 months post-injury. Researchers considered radiographic angular alignment, grip strength and wrist mobility as outcome measurements.
Results showed 65.4% of cases had dorsal angulation. Researchers found a decrease in mean angulation from 12.8° at 4 weeks post-injury to 6.3° at 6 months post-injury and 3.6° at 1-year post-injury, with 75% of cases presenting with fracture angulation less than 5°. Up to 6 months post-injury, patients had significantly diminished grip strength in the affected hand vs. the unaffected hand, according to results. However, researchers noted no significant differences in grip strength between the affected and unaffected arm after 1-year follow-up. Results showed the affected and unaffected arm had no significant differences in function after 1-year post-injury.
The results of this study confirm the potential of good remodeling in children with angulated forearm fractures, according to Ploegmakers, and that surgeons should “think twice about the necessity of fracture reposition” in young children with a distally located fracture.
“Remodeling mostly takes place between 4 weeks and 6 months after fracture in which also function shows good recovery,” Ploegmakers told Healio Orthopedics. “In daily practice, we recommend to continue follow-up for at least half a year, thereby evaluating radiographs and functional outcome using grip strength measurements. Grip strength should be used more often to evaluate functional outcome since it showed good correlation with fracture angulation.” – by Casey Tingle
Disclosures: Ploegmakers reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Warren C. Hammert, MD
The authors have performed a nice prospective study evaluation and hand function, based on motion and strength, of nonreduced pediatric forearm fractures, giving the idea that maybe we don’t need to reduce forearm fractures in all circumstances. This is a compelling study and the results are notable. They have looked at age ranges from 3 to 13 years and demonstrated that, after 6 months, the function is similar to the non-injured side. There are many differences in a 3- and 13-year-old, particularly related to the remaining growth potential and potential long-term changes in function.
The location of the fracture in the forearm is important as a fracture that is in the distal third at the time of injury, especially in a younger patient, moves proximal as the child grows. As the fracture site is more proximal, the distal radioulnar joint will be less tolerable of angulation and distal radioulnar joint incongruency and instability may result over time. Because of this, providers should inform families that patients may benefit from long-term follow-up and there is potential to need future intervention even though the child is doing great at 1 year post-injury.
Chief, division of hand surgery
University of Rochester
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