Forearm Fractures In Adolescents Research Articles

Diaphyseal forearm fracture management in adolescent patients from 2011 to 2020: A multicenter study of surgery and regional anesthesia trends

BackgroundDiaphyseal forearm fractures are common traumatic injuries among children. There has been much debate on the use of intramedullary nailing (IMN) or plate fixation in the adolescent population (10–16 years of age). Furthermore, as ultrasound technology has advanced, the safety and efficacy of ultrasound-guided axillary brachial plexus block for children has dramatically improved. Therefore, anesthesia options for adolescent patients have increased in recent years. This study aimed to investigate recent surgical and regional anesthesia trends of diaphyseal forearm fractures in patients 10 to 16 years of age in Japan through a multicenter epidemiological survey from 2011 to 2020. MethodsThis retrospective, multicenter study included 226 pediatric patients with diaphyseal forearm fracture aged 10–16 years treated from January 2011 to December 2020. We divided the patients into four groups according to the period in which they were treated: early (2011–2013), middle (2014–2016), late (2017–2019), and COVID-19 (2020). Information from medical records was used to investigate the number of surgeries, types of anesthesia administered, and internal fixation methods used for diaphyseal forearm fracture in adolescent patients during each period. ResultsThe number of surgeries was generally constant in each period but decreased during the COVID-19 period. In the early, middle, late, and COVID-19 periods, the percentages of surgeries performed under regional anesthesia were 67.7, 85.5, 87.0, and 100% respectively (p = 0.003). During the same periods, the percentages of patients receiving IMN were 41.5, 49.3, 58.0, and 66.7%, respectively (p = 0.033). ConclusionThe use of IMN and regional anesthesia to treat diaphyseal forearm fracture in patients 10 to 16 years of age steadily increased during the study period from 2011 to 2020. These results indicate that regional anesthesia is safe, effective, and well-tolerated by adolescent patients. The treatment strategy for diaphyseal forearm fractures in adolescents using regional anesthesia in combination with IMN worked well and was effective during COVID-19. Our evidence suggests this trend will continue. We anticipate that our findings can be extrapolated for upper extremity fractures in adolescent patients beyond the Tokai region of Japan where the study was based.

Functional Outcome of Titanium Elastic Nail Fixation in Diaphyseal Fractures of Forearm in Adolescents

Introduction: This study aims to assess the functional outcomes of Titanium Elastic Nailing System (TENS) fixation for managing diaphyseal forearm fractures in adolescents. Method: The study was a prospective clinical study conducted at B.P. Koirala Institute of Health Sciences Between December 1, 2020, and November 30, 2021. Ethical clearance was obtained from the Institutional Review Committee (Registration Number 305/077/078-IRC). A total of 27 patients who underwent TENS fixation for forearm diaphyseal fractures were included. Patients were followed at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Radiological and functional outcome evaluations were assessed, including the range of motion, deformity, and time taken for union and active recovery. Collected data were entered in Microsoft Excel and converted to SPSS (Statistical Package for Social Sciences) version 28 for statistical analysis. Results: Among 27 included patients, 66.7% were males, 81.5% were within the age group of 10-13 years, 70.4% fell on outstretched hands, and 66.7% had fractures at the middle third of the forearm. Union was seen in 6 weeks among 29.6%, 12 weeks among 66.6%, and 24 weeks among 3.8%—7.4% developed complications. Conclusion: TENS is an effective fixation method for diaphyseal forearm fractures in adolescents and provides satisfactory functional outcomes. Keywords: Adolescents; Forearm bone fractures; Functional outcome; TENS

Characteristics of forearm refracture in adolescents.

The purpose of this study was to evaluate characteristics of reinjury following forearm fractures in adolescents. An Institutional Review Board-approved retrospective cohort study of forearm fractures (ages 10-18 years) treated by a single academic pediatric orthopaedic group from June 2009 to May 2020 was conducted. All both bone forearm (BBFA) and radius or ulna primary and secondary injuries were included. We excluded open, surgically treated, physeal, epiphyseal, and radial head/neck fractures. Demographics, injury characteristics, and radiographic data were recorded. We evaluated associations of ipsilateral same-site refracture (RE-FRACTURE) versus ipsilateral or contralateral different-site forearm fractures occurring as secondary later injuries (OTHER). Thirty-three of 719 patients sustained a secondary forearm fracture (4.6%; mean age, 11.5 years; M:F, 5.6:1). RE-FRACTURES, compared with OTHER forearm locations, were associated with a sports mechanism at time of original injury ( P = 0.024) and mid-shaft position of fracture on the radius (77.6 vs. 29.8 mm from distal physis; P < 0.001) and ulna (72.0 vs. 27.2 mm from distal physis; P = 0.003). RE-FRACTURES also demonstrated increased radius to ulna distance between BBFA primary injury sites on anteroposterior (19.6 vs. 10.6 mm; P = 0.009) and lateral radiographs (19.6 vs. 10.5 mm; P = 0.020) compared with OTHER forearm locations. Residual angulation and fracture-line visibility were not significantly associated with secondary fracture. Ipsilateral same-site refractures tend to occur in adolescents within 1 year following treatment for widely spaced (>15 mm) and mid-shaft forearm fractures incurred during athletic activity. Further research may be warranted to evaluate biologic, bone health, or personality traits that may lead to secondary fractures of the pediatric forearm.

Trends in Operative Treatment of Pediatric and Adolescent Forearm Fractures Among American Board of Orthopaedic Surgery Part II Candidates.

Pediatric and adolescent forearm fractures are among the most common injuries treated by orthopaedic surgeons. Recent literature shows that there has been an increased interest in operative management for these injuries. The purpose of the current study was to examine the trends in case volume, patient age, surgeon fellowship training, and postoperative complications of surgically treated pediatric forearm fractures over >15-year period of American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination candidates. ABOS Part II candidates' Oral Examination Case List data from 2003 to 2019 was queried for all pediatric and adolescent (19 y of age and below) forearm fractures treated operatively. Patient demographics, fracture type, complications, and candidate fellowship type were identified for each case. Linear regression was used to delineate annual trends in patient age, complication rates, and case volume by fellowship type. Analysis of variance was performed to evaluate complication rates by fellowship type. Statistical significance for all comparative analyses was set at P-value <0.05. A total of 4178 pediatric and adolescent forearm fractures (mean age: 12.6 y; SD: 3.7 y) were treated surgically among ABOS Part II Oral Examination candidates during their 6-month collection periods from 2003 to 2019. The mean patient age decreased significantly (P<0.001) over the study timeframe, while complication rates increased (P<0.001). Pediatric fellowship-trained orthopaedic surgeons performed significantly more cases than general orthopaedic surgeons over recent years (P<0.001). No significant trends were identified between fellowship type and complication rates. The overall surgical complication rate was 17%. The complication rate of open fractures was 24%, which was significantly >15% complication rate of closed fractures (P<0.001). Fellowship-trained pediatric orthopaedic surgeons are performing an increasing number of pediatric and adolescent forearm fracture fixation when compared with other orthopaedic surgeons. The mean age of surgically managed pediatric forearm fracture patients has decreased from 2003 to 2019. There has been an increase in the rate of overall reported complications following pediatric forearm fracture surgery over recent years, without any significant association to any particular subspecialty. Future studies should evaluate the comparative effectiveness of surgical treatment of pediatric forearm fractures compared with closed management.

The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment.

Aim Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/ forearm fracture. Methods A total of 43 patients who presented with distal radius/ forearm fractures were enrolled and divided into two groups: 23 patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS). Results In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the third month after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05). Conclusion The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physician is the choice of surgical technique and fixation method, which will be influenced by individual experience and preference. The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.

Forearm diaphyseal fractures in the adolescent population: treatment and management.

Pediatric both-bone diaphyseal forearm fractures are commonly treated in a variety of clinical settings. Most often, closed reduction followed by immobilization leads to satisfactory results. However, in the adolescent population (10-16 years of age), forearm fractures are more challenging due to less remodeling potential. The purpose of this review was to provide an overview of the anatomy, biomechanics, and treatment options relevant to adolescent patients. A systematic review of peer-reviewed publications and abstracts related to the treatment for pediatric both-bone diaphyseal forearm fractures in adolescents was carried out. Forearm fractures in the pediatric population are most common following indirect blows to the forearm. When treating these fractures using closed reduction, it is important to recognize the muscular attachments of the forearm. In roughly 70-90% of cases, closed reduction leads to adequate alignment. In all cases, return to function is the primary goal; however, exact alignment parameters remain controversial. In the adolescent population, surgical treatment has risen substantially in the last few decades. Intramedullary nailing and open reduction using plate fixation are the two most common operative techniques. Unfortunately, recent results have shown that nonunion, malunion, and overall complication rates are higher in older pediatric patients. Moreover, no consensus exists regarding one technique over another. Both-bone diaphyseal fractures in the adolescent population present unique challenges regarding optimal treatment, especially when considering surgical intervention. Further research is necessary to better understand indications for specific surgical treatment.

A 5-year Overview of Forearm Fracture Etiology and Treatment Options in 7-15 Years Old Children

SummaryIntroduction.Forearm fractures make up a significant part of overall fracture rate in pediatric population, especially in 7-15 years old children. Different methods of treatment have been used, depending on the age of children and type and localization of fracture. Most controversies can be seen among conservative and surgical methods of treatment.Aim of the Study.The aim of our study is to identify common localizations and types of forearm bone fractures in pediatric population, as well as analyze patient data and treatment process depending on selected method of treatment for out-patients and in-patients.Materials and Methods.Retrospective analysis of out-patient and in-patient records, treated in University Children’s hospital from 2007 to 2011 was made, including first time patients with fractures of one or both forearm bones, according to ICD-10 codes S52.0- S52.9. Demographical data, trauma mechanisms, localization and type of fracture, as well as applied treatment and stay length at hospital were analyzed. 1742 out-patients and 1029 in-patients, 7-15 years old at the moment of trauma, were included in this research.Results.2771 forearm fractures were registered, 62.9% patients were treated on out-patient basis, 37.1 % patients required treatment in hospital. Forearm bone fractures were gender specific - 2235 boys and 536 girls had to be treated (Male:Female ratio was 4.2 : 1). The peak incidence was seen in 13 years old boys and girls. Boys suffered from forearm fractures more often in any age group. Most common mechanisms of injuries causing forearm fractures in children were related with sports trainings - 22.1%, skiing - 15.0% and traffic injuries - 10.0%. Most common activities at the moment of trauma differ by season - during winter months they include skiing, skating and sledging while in summer falls from height, bicycles and swings are dominant. Several trauma mechanisms, like sport trainings, are not season-dependent. Some injury mechanisms differ significantly by gender. Boys were more often as girls injured during sports trainings and skiing, while girls experience forearm fractures due to bicycling and skating. Occurrence of forearm fractures in children has seasonal differences with two peaks: from June to August and from December to February. Distal forearm fractures are the most often seen localization of overall forearm fractures (42 % in boys and 36 % in girls). In out-patients group conservative treatment was performed - plaster immobilization in 1339 cases and closed reduction, followed by plaster immobilization in 403 cases. In-patients were treated both - conservatively with immobilization in 21 cases and closed reduction in 188 cases, and surgically with K-wire osteosynthesis in 137 cases or elastic stable intramedullary nailing (ESIN) in 683 cases. The type and localization of each fracture, along with the age of patient, are the key factors for choosing the right treatment method. K-wire osteosynthesis was performed in all age groups for unstable fractures in distal or proximal third of forearm. ESIN was a method of choice for unstable or comminuted midshaft fractures of one or both bones, metadiaphyseal fractures and some specific conditions (radial neck fractures, Monteggia fractures-dislocations), especially in older patients. Stay length at hospital was ranging from 1 to 2 hospital days in case of immobilization (mean = 1,05 days), from 1 to 4 days in closed reduction group (mean = 1,32 days), but 1 to 12 days in hospital spent children after K-wire osteosynthesis (mean = 1,99 days) or ESIN (mean = 2,38 days).Conclusions.1. Forearm fractures in children have a significant gender diversity (M : F ratio is 4,2 : 1).2. Peak incidence group is 13 years old adolescents of both genders.3. Seasonality and season-specific injury patterns are typical for pediatric forearm fractures.4. The most common anatomic localization is the distal segment of forearm bones.5. Younger children (7-9 years) are mainly treated by conservative methods, while methods of choice for treatment of forearm fractures in adolescents (13-15 years) are operative.6. Surgical treatment of fractures do not significantly increase stay length at hospital.

Is Bone Mineral Mass Truly Decreased in Teenagers With a First Episode of Forearm Fracture? A Prospective Longitudinal Study

Forearm fractures are common in the pediatric population and are mostly treated by cast immobilization. The purposes of this study were first to determine whether forearm fractures in adolescents are associated with abnormal bone mineral density (BMD) or content (BMC) at the time of fracture, and second, to quantify the bone mineral loss at various sites due to cast-mediated immobilization. This longitudinal case-control study recruited 50 adolescents (age, 12.8 ± 1.8 y) who underwent cast-mediated immobilization for a forearm fracture and 50 healthy controls (13.0 ± 1.8 y). Using 2 dual-energy x-ray absorptiometries, BMD and BMC were measured at various skeletal sites (total body, lumbar spine, total upper limb, and forearm) at fracture time and at cast removal. At the fracture time, BMD/BMC Z-scores at the lumbar spine and areal BMD at the peripheral wrist were not different among the injured and the healthy subjects. At cast removal, significant BMD decreases were observed in adolescents with fracture at the level of the radial and the ulnar diaphyses (-5.6% and -3.8%, respectively) and the total upper limb (-5.6%) compared with the noninjured side. Significant decreases in the BMC values were observed at the level of the radial diaphysis (-6.4%), ultradistal ulna (-10.2%), total upper limb, and total ulna (-8.2% and -4.9%, respectively). These data demonstrate that total body, lumbar spine, or wrist bone mineral mass and density (BMC and BMD) are not reduced at the fracture time in adolescents sustaining a first episode of upper limb fracture when compared with healthy subjects. These findings suggest that forearm fractures are not related to osteopenia in youth. In addition, cast-mediated immobilization results in a significant bone mineral loss at the upper limb, which may explain the increased risk of sustaining a second fracture. Finally, bone callus formation may interfere when assessing bone mineral mass after cast removal and may lead to an erroneous underestimation of bone mineral mass decrease. Level IV.

Outcome of elastic nailing of diaphyseal forearm fractures in adolescents after failure of conservative management

This is a prospective study to evaluate the efficacy of elastic nails for the treatment of diaphyseal forearm fractures after failure of conservative management. In 35 patients with a mean age of 15.3years (14-17years), elastic nails were used for the treatment of diaphyseal forearm fractures after failure of conservative management. In 32 patients (91.4%), we performed closed reduction. In the remaining 3 (8.6%), closed reduction failed and an open reduction, through a minimal approach, was required before nailing. After a mean follow-up of 31months (range 24-48months), 20 (60%) patients had an excellent result 10 (34.3%) patients had a good result, and two (5.7%) patients had fair result. The mean time of union was 12weeks (range 8-15). The mean time in cast was 8.5weeks (range 7-11). Full range of elbow movement was regained in all cases; however, supination and pronation were limited in two patients. One patient had a superficial infection at the site of entry of the ulnar nail which was successfully treated with oral antibiotics and daily dressing. Neurapraxia affecting superficial branch of the radial nerve in one patient was resolved over a period of time. One case with partial rupture of extensor pollicus longus tendon was reported. There was one case of delayed union. No cases of refracture were reported after removal of the implant. In adolescents, intramedullary fixation by using elastic nail plus cast immobilization provides effective treatment for diaphyseal forearm fracture when closed management has failed. However, it is of special importance to follow the right indication and to pay attention to correct technical procedure.