Factors affecting early re-displacement of paediatric diaphyseal forearm fractures at Korle Bu Teaching Hospital.

Daniel Agbley,Henry Holdbrook-Smith,Kissinger Marfo,Yao Ahonon,Michael Segbefia

doi:10.4314/gmj.v54i3.5

Abstract

Complete fractures of the forearm have the potential to displace and angulate with overriding fracture fragments. Maintaining acceptable reduction is not always possible, and re- displacement or re-angulation is the most commonly reported complication. Factors responsible for the re-displacement after an initial acceptable reduction have not been clearly defined. The study aimed to determine the factors that influence early re-displacement of paediatric diaphyseal forearm fractures in Korle-Bu Teaching Hospital. A prospective study in a cohort of 72 children below the age of 12 years with diaphyseal forearm fracture attending the Orthopaedic clinic were followed with close reduction casting from April 2017-December, 2017. Factors analysed included demographics, initial fracture features and the radiographic indices of the cast quality. 93.1% (67) of the fractures were because of the children falling on an outstretched arm. Majority of the children had a fracture of the distal 1/3 of the radius (n=38, 52.6%). The overall C.I was 0.8 (SD 0.1). The only significant predictor for predicting re-displacement was children falling on an outstretched hand (p-value=0.0). This study has shown that the degree of initial displacement and the ability to achieve good reduction with a well moulded cast, constitute the major factors for early re-displacement of paediatric forearm fractures. Personal funding.

Highlights

Diaphyseal or shaft fractures of the forearm are fractures occurring between the proximal and distal metaphysis of the either or both ulna and radius
Redisplacement is a displacement of a fracture within two weeks after closed reduction and cast immobilisation which leads to malunion
This finding contradicts the study done by D Borton et al which demonstrated that paediatric forearm fractures are common in the non-dominant hand.[9]

Summary

Introduction

Diaphyseal or shaft fractures of the forearm are fractures occurring between the proximal and distal metaphysis of the either or both ulna and radius. The metaphysis is the diverging area of the bone between the diaphysis (shaft) and the physis (growth plate) radius and ulna naturally heal rapidly with an excellent functional outcome if the reduction is maintained. Forearm fractures are one of the most common fractures occurring in children. It accounts for 39% of all pediatric fractures[1], which commonly arises as a result of a fall on an outstretched arm. Forearm fractures are often managed conservatively with closed reduction and cast immobilisation. Redisplacement is a displacement of a fracture within two weeks after closed reduction and cast immobilisation which leads to malunion

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Discussion

Conclusion