Re-reduction of pediatric both bone forearm fractures may not improve outcomes
Key takeaways:
- Older patient age was associated with a pronosupination deficit after treatment of both bone forearm fractures.
- Patients older than 8 years had decreased functional outcomes with repeat closed reduction.
SAN DIEGO — Results presented here showed repeat closed reduction for both bone forearm fractures in patients older than 8 years resulted in a higher rate of pronosupination deficit and decreased functional outcomes.
“The most meaningful result with this study was that if you were to consider re-reducing patients with pediatric both bone forearm fracture, you now have added data to counsel the patients that with a re-reduction attempt, it may not affect functional outcomes,” Michael Murphy, MD, of Loyola University Medical Center, told Healio about results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
Murphy and colleagues collected patient data, injury variables, treatment variables and radiographic measurements of alignment after reduction and union among 112 patients with both bone forearm fractures treated at two urban level-1 trauma centers.
“We were trying to answer the question: What are the alignment criteria for treating these patients nonoperatively?” Murphy said in his presentation. “Center A was more strict, and center B was less strict in terms of alignment criteria.”
According to the abstract, outcomes included forearm pronosupination, pediatric upper extremity Patient-Reported Outcome Measurement Information System (PROMIS) scores and grip strength.
Among the patients included in the study, 50 patients were from center A and 62 were from center B.
Murphy said surgeons at center A performed more re-reductions compared with those at center B. Although surgeons at center A produced alignment closer to the native alignment, Murphy said this result was not maintained at time of union.
“When you look at the deformity at union, overall, the sagittal plane tended to have a higher deformity compared to the coronal plane,” Murphy said.
He said pronosupination deficit was associated with older patient age but was not associated with angulation seen in the radiograph. Murphy said sagittal angulation greater than 15° at union and axis deviation greater than 6.5° were associated with lower PROMIS scores.
“We definitely want to study the patient cohort with reduced outcomes, specifically the patient cohort over the age of 8 years old,” Murphy told Healio. “What we found in our study was that they had reduced outcomes in terms of function. We want future studies to focus on an intervention that can help them the most. Additionally, we also know that this cohort has reduced remodeling potential.”
Michael Murphy, MD, of Loyola University Medical Center, can be reached at mike.p.murphy2@gmail.com.
Collapse
Marshall A, et al. Paper 172. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
Read more about