Abstract
PurposeThis 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.MethodsWe 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.ResultsConservative 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.ConclusionsThere 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.
Highlights
Forearm fractures are the most common type of fractures in the pediatric population, but, to date, no comprehensive overviews of their epidemiology are available.Naranje et al using the 2010 NEISS report, estimated in children aged 0 to 19 years, 5,333,733 emergency room (ER) visits, of which 788,925 (14.7%) were fracture related
Pediatric forearm fractures typically follow indirect trauma, such as a fall on an outstretched hand coupled with a rotational component [9]
The authors observed an increase of 62% in surgical treatment of forearm fractures occurred during this time compared with previous years
Summary
Forearm fractures are the most common type of fractures in the pediatric population, but, to date, no comprehensive overviews of their epidemiology are available. Open reduction and use of plate fixation make stabilization and anatomic reduction of forearm fractures, as well as more complete correction of malrotation and restoration radial bow so as to allow early range of motion [57] This approach has been debated as it leads soft-tissue dissection periosteal stripping, needed for exposure and fixation. Elhalawany et al [65] conclude that hybrid fixation technique (plating of ulna and elastic nail for radius) in adolescent forearm fracture seem to be a satisfying option in managing these injuries and seem to reduce the problem of ulnar nonunion encountered when using elastic stable intramedullary nail in that age group. They found that the patient treated with IM nailing needed of more time to heal and achieve radiographic union They suggest better outcomes and lower complication rate with plate fixation in the adolescent. Based on the available literature we create an operative flowchart in order to help the surgeons for the best treatment decisions (Fig. 7)
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