The modified Sauvegrain method guides the treatment of forearm fractures in adolescents

Abstract

BackgroundForearm fractures are the most common paediatric fractures. While successful management in the preadolescent is often conservative, outcomes in adolescents have greatly improved with intramedullary Titanium Elastic Nail System (TENS) and rigid plate fixation. However, there have been no objective criteria for determining when TENS may be used in adolescents. This study aimed to compare the modified method of Sauvegrain et al. (2005) for skeletal age scoring against chronological age to predict treatment outcomes in adolescents with a forearm fracture treated by TENS and subsequently determine the skeletal age limits of TENS in adolescents. Patients and methodsThis was a single-centre retrospective study of adolescents aged 10–16 years with an isolated, complete diaphyseal forearm fracture managed surgically from January 2014 to 2018. The modified Sauvegrain method provided skeletal age scoring via elbow radiographs. Functional outcomes were classified into good and poor groups by considering the treatment complication, range of motion and functional ability at the final review one year after intervention. ResultsThere were 128 TENS patients, comprising 15 females and 113 males. On average, males displayed older skeletal age than chronological age with a mean (SD) difference of 1.29 (1.03) years (p < 0.001). The modified Sauvegrain method score was the sole independent predictor of poor treatment outcome in males (AUC 0.71, 95 % CI 0.59–0.83). The Youden J-index identified a modified Sauvegrain method score of ≥26 as statistically predictive of high risk of a poor treatment outcome in TENS-treated male adolescents. ConclusionThe correlation of chronological age to skeletal suitability for TENS treatment is unreliable in adolescents. The modified Sauvegrain method helps determine the skeletal age and should be part of the decision-making in employing TENS. At modified Sauvegrain method score ≥26, the decision for using TENS in male adolescents as treatment should be re-evaluated. Level of evidenceLevel III therapeutic study.