Forearm Fractures Research Articles

Outcome of Locking Compression Plate (LCP) Fixation of Diaphyseal Radius-Ulna fracture in Patients of 50 Years and Above

A prospective, observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from January 2018 to December 2019, to evaluate the effectiveness of locking compression plate (LCP) fixation in treating diaphyseal forearm fractures. A total of 34 adults aged 50 and above, a population with a high prevalence of osteoporosis, were selected for this study. With an average follow-up period of 25.27±1.39 weeks, the study found that older age and delayed surgery correlated with poorer outcomes, while motor vehicle accidents accounted for 52.94% of the injuries. The average time to radiological union was 12.18±1.53 weeks, with one case of nonunion and a complication rate of 11.76%. At the final follow-up, the mean range of motion for flexion-extension and supination-pronation was 133.53°±5.44° and 124.41°±11.19°, respectively, and the mean Quick DASH score was 14.6%±7.14%. According to the Anderson criteria, 50% of cases were rated as excellent, 47.06% as good, and 2.94% as poor. The study concludes that LCP fixation is an effective treatment for diaphyseal forearm fractures in this age group, demonstrating favorable outcomes regarding union rates, pain management, and functional recovery, with meticulous surgical technique being key to optimal results. Mugda Med Coll J. 2024; 7(2): 95-101

Outcomes of displaced mid-shaft radius/ulna fractures in children treated with the Rang method: a pilot study.

Pediatric forearm fractures of the radius and ulna are common. Previous literature suggests that conservatively managed mid-shaft radius and ulna forearm fractures have a remanipulation rate of 10-70%. The purpose of this study is to compare the re-displacement rate of closed displaced mid-shaft both-bone forearm fractures (BBFF) in children treated with closed reduction and casting with a loop and sling applied proximal to the fracture site (Rang method) compared with a standard sling. A retrospective review was performed of 42 patients under the age of 14 with BBFF treated over a 4-year period. The average patient age was 7 years. Data analyzed included demographics, mechanism of injury, presence of a pulse, presence of nerve injury, incidence of compartment syndrome, sling type, loss of reduction, remanipulation, and need for surgical fixation. Loss of reduction was defined as a final number of >15° angulation if age <10 years old and >10° angulation if >10 years old. Fifteen patients (36%) were treated with the Rang method. Twenty-seven patients (64%) were given a standard sling. Only one patient (7%) managed with the Rang method lost reduction, whereas 17/27 patients (63%) given a regular sling lost reduction and required remanipulation (P = 0.0004). Treatment of a BBFF in a child aged <14 years typically involves closed reduction and casting. The 'Rang' method of placing a loop and attached sling proximal to the fracture site is a casting pearl that helps to minimize fracture redisplacement.

Is the occurrence of deep vein thrombosis related to the fracture site? A two-sample Mendelian randomization study

ABSTRACT Objective Deep vein thrombosis (DVT) is a known complication of fractures. This study aimed to explore the genetic causal relationship between DVT and fracture sites. Research design and methods The exposures analyzed in this study included fracture of femur (FFE), fracture of lower leg, including ankle (FLLA), fracture of shoulder and upper arm (FSUA), fracture of forearm (FFO), fracture of rib, sternum and thoracic spine (FRSTS) and fracture of lumbar spine and pelvis (FLSP). DVT as the outcome. A two-sample Mendelian randomization (MR) approach was employed to investigate the genetic causal relationship, and a series of sensitivity analyses were conducted. Results The findings indicated no genetic causal relationship between FFE (p = 0.569, OR 95% CI = 1.001 [0.998–1.003]), FLLA (p = 0.371, OR 95% CI = 0.999 [0.995–1.002]), FSUA (p = 0.871, OR 95% CI = 1.000 [0.998–1.002]), FFO (p = 0.281, OR 95% CI = 1.001 [0.999–1.002]), FRSTS (p = 0.346, OR 95% CI = 0.999 [0.996–1.001]) or FLSP (p = 0.759, OR 95% CI = 1.000 [0.999–1.002]) and DVT. Sensitivity analyses reinforced the robustness. Conclusions This study indicate that no genetic causal relationship exists between DVT and fracture site, the observed association may be attributable to non-genetic factors.

Trends and Economic Implications of Operative Management for Pediatric Forearm Fractures: A Retrospective Study

Trends and Economic Implications of Operative Management for Pediatric Forearm Fractures: A Retrospective Study

Treatment of both bone forearm fractures with 2.7mm plates: a non-inferiority study.

To determine the effectiveness of 2.7mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5mm fixation. More specifically, to determine if 2.7mm plates are non-inferior to the current standard of 3.5mm plates. Retrospective including patients from 2016-2021. Single institution, level-1 trauma academic medical center. 77 patients met inclusion criteria, 58 patients underwent fixation with 3.5mm plates and 19 underwent fixation with 2.7mm plates. Plate osteosynthesis with either 2.7mm or 3.5mm plate instrumentation. Maintenance of reduction and achievement of fracture union. Among 77 total patients, 19 received 2.7mm plates and 58 received 3.5mm plates. There was no difference in age and BMI between groups, but the 2.7mm group had fewer males (47% vs 79%, p = 0.02). Primary end points of achievement of union (89.5% vs. 79.3%, p = 0.39) and maintenance of reduction (100% vs. 94.8%, p = 0.99), and secondary end points of implant removal (15.8% vs. 13.8%, p = 0.79), return to the operating room (OR) (5.3% vs. 5.2%, p = 0.63), and minor complications (0% vs. 6.9%, p = 0.99) were similar between the 2.7mm and 3.5mm groups. This study challenges the current standard of ORIF using 3.5mm plates for diaphyseal forearm fractures. 2.7mm plating resulted in at least equivocal achievement of fracture union and thus may be more efficacious given previous studies showing lower refracture risks after implant removal. Level III, retrospective cohort study.

Outcomes of Management of Pediatrics Both Forearm Bone Fractures by Using Titanium Elastic Nailing System

Background: Forearm fractures include 25% of all infantile complaints. Forearm fractures account for 30 to 50% of all paediatric fractures and boys were more prone to forearm fractures. Paediatric diaphyseal bone fractures can be treated conventionally through closed manual reduction and casting as the abilities of the paediatric bones to remodel.Titanium Elastic Nails (TENS) is extensively used in children because it is innocuous. The aim of the study to recognize the management of pediatric bone forearm fractures using TENS. Materials and methods: A prospective study was carried out in the Department of Orthopedics, Chattagram Maa-O-Shishu Hospital Medical College from January 2018 to June 2022. A total of 45 patients (n=45) were enrolled in this study. Verbal consent was taken before recruiting the study population. Ethical clearance was taken from the hospital. The information was kept confidential only to be used for the study purpose. Results: Around three-fourths of the study population (34,75.6%) were male and only eleven patients were female and forty-two patients (42,93.3%) had no complaints of strenuous activity. Fractures involved the middle third in the most of the patients (22,48.9%). Closed reduction and internal fixation with titanium elastic nail system were done in forty-four patients (44,97.8%) and the result was excellent in most of the patients (42,93.3%) and satisfactory in three patients (3,6.7%.) Conclusion: Closed reduction and internal fixation with TENS appears to be acceptable treatment preference for the fixation of paediatric bone fractures. It provides exceptional functional consequences in terms of the range of motion and grip strength without chief complications. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 19-23

Clinical consequence of the 4-week X-ray control after ESIN osteosynthesis of forearm fractures in children

PurposeThe absence of evidence based general guidelines for radiographic follow-ups of pediatric diaphyseal forearm fractures treated with ESIN results in an arbitrary array of X-ray examinations. In most pediatric traumatology departments, an X-ray check is carried out 4 weeks after ESIN osteosynthesis of forearm shaft fractures to detect incipient consolidation of the fracture. However, the elevated sensitivity to ionizing radiation requires special precautions in the pediatric populations. To prevent the indiscriminate use of this diagnostic tool it is necessary to assess the consequence of routinely taken X-rays at the 4-week follow-up.MethodsThis retrospective analysis included 219 pediatric patients who underwent ESIN treatment for a diaphyseal forearm fracture between 2010 and 2018 at the same pediatric trauma center. The primary outcome was defined as the prevalence of aberrant radiographic findings (ARF) during the 4-week follow-up with an otherwise normal clinical course and examination. Pathologies in the physical exam and irregularities in the medical history were summarized as non-radiological abnormalities (nRD). Binary logistic regression was calculated to identify risk factors associated with an increased likelihood of an ARF.ResultsOf the 219 pediatric patients included, 123 patients had no nRDs at the 4-week follow-up. Only one patient was found to have an ARF (absolute risk = 0.008). Regression showed that the odds of receiving an ARF increased significantly as other nRDs were detected (p = 0.012, OR 14.554). A positive correlation was found especially for irregularities in the medical history (n = 59, p = 0.003, OR = 8.134).ConclusionThis study provides evidence that standardized radiographic follow-up 4 weeks after surgical treatment has no clinical consequences if the course of the fracture is otherwise uneventful. It should be strictly reserved for pediatric patients with a complicated course.

Validating Fibula Length as a Reliable Estimator for Femoral Nail Length: A Comparative Analysis with the Standard AO Method

INTRODUCTION: An appropriate femoral nail length is required to be measured preoperatively to ensure optimal surgical outcomes. Conventionally, measurements are obtained clinically or radiographically on the contralateral femur or by using forearm referencing. This study is aimed to determine whether fibula length can be used as an additional clinical method for estimating maximum femoral nail length. MATERIALS AND METHOD: This study involves measuring the femurs and fibulas of 140 patients using a standard tape measure. Femur length is measured adhering to the standard Arbeitsgemeinschaft für Osteosynthesefragen (AO) method, while fibula length was measured from the tip of the fibula head to the tip of the lateral malleolus. Pearson correlation coefficient (r) determines any correlation between the two measurements. RESULTS: The overall mean femoral length was 37.98cm (SD=2.72), with a range of 32.0 to 46.5 cm, and the mean fibula length was 37.72cm (SD=2.61), with a range of 32.4 to 47.0 cm. A robust and positive correlation (r=0.940, p&lt;0.001) was observed between fibula length and femoral length. Age, body mass index, and gender did not affect this correlation. Both inter-observer and intra-observer reliabilities were high. A formula for estimating maximum femoral nail length was derived from the correlation graph: femoral nail length = 1 + (0.98 x fibula length). CONCLUSION: Fibula length demonstrates a strong correlation with femoral length, offering a reliable alternative clinical method for estimating femoral nail length. This method proves particularly useful in cases of bilateral femoral fractures with concurrent forearm fractures where forearm referencing method is impractical.

Does Resident Gender or Race/Ethnicity Affect Orthopaedic Surgery Case Volume During Residency Training?

Disparities in case volumes have been reported in some surgical specialties. The objective of this study was to evaluate whether gender or racial/ethnicity disparities exist during orthopaedic surgery residency surgical case log volume. Accreditation Council for Graduate Medical Education Case Log Database for orthopaedic surgery residents for 9 years of cohorts graduating in academic years 2013-2014 to 2021-2022 were analyzed to compare case logs between men and women, as well as race/ethnicity, defined by Association of American Medical Colleges as underrepresented in medicine (URiM) and non-URiM groups. Longitudinal analyses of total required minimum type cases indicate significant gender differences among the initial graduating cohorts with women trainees reporting 33 cases fewer than men; in the most recent years of this study period, women trainees reported 5 cases fewer than men per year. URiM trainees reported 29 cases fewer at baseline, while in the most recent years, there were no significant differences. Significant differences exist for 8 of the 15 case minimum types with fewer women cases at baseline; in the most recent years, women had fewer cases in anterior cruciate ligament Reconstruction, Ankle Fracture Fixation, Closed Reduction Forearm Fracture, Total Hip Arthroplasty, and Total Knee Arthroplasty. There were significant differences for 3 of 15 case minimum types at baseline for URiM trainees with no significant differences in most recent years. Hand was the only anatomic area with women reporting significantly more cases than men, both initially and over the 9 years of study period. Significant differences exist in case volume and case types during orthopaedic surgery residency based on gender for the initial cohort, albeit lessening in most recent years. Although initial differences in cases volumes based on race/ethnicity exist, no significant differences persist in most recent years of the study period. Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment of a Rare Case of Longitudinal Forearm Instability: A Case Report.

A 41-year old man fell from height sustaining displaced radial shaft and ulnar styloid fractures underwent open reduction internal fixation of the radius with early recognition of a radiocapitellar dislocation and longitudinal forearm instability in the early postoperative period. Revision surgery was performed 13 days postoperatively involving annular ligament reconstruction, elbow spanning external fixation, and distal radioulnar joint stabilization. Favorable functional and radiographic outcomes are shown at 1-year follow-up. Longitudinal forearm instability is associated with multiple patterns of forearm fractures. Early recognition of the injury with appropriate anatomic reconstruction likely results in improved outcome.

Effectiveness of Hybrid Fixation in the Treatment of Proximal Diaphyseal Both Bone Forearm Fractures in Adolescents.

Pediatric diaphyseal both-bone forearm fractures are one of the most prevalent fractures in orthopedic practice. To assess the anatomical and functional outcomes of hybrid fixation (radius nailing and ulna plating) in treating closed proximal radius and ulna fractures in adolescents. This prospective cohort study was performed on 41 patients between the ages of 10 and 16 years, both sexes, with recent trauma (less than 2 weeks) suffering from closed proximal diaphyseal radius and ulna fractures. Functional outcomes were assessed according to the price score grading criteria, along with the radiological assessment of the union. Regarding Price score grading, 28 (68.29%) cases had an excellent function, 8 (19.51%) had a good function, 3 (7.32%) had a fair function, and 2 (4.88%) cases had a poor function. The mean union time was 7.41 ± 2.65 weeks. Four patients complained of prominent hardware, three cases developed neuropraxia resolved, and two cases had nonunion of both bones and one of them had nail migration. The hybrid fixation technique could be effectively used in the treatment of adolescent proximal both-bone forearm fractures.

Enhancing Pediatric Forearm Fracture Management: The Role of Extension Casting in Reducing Repeat Interventions

Background: Fractures of the forearm are common in the pediatric population, often requiring careful management to ensure optimal outcomes and minimize long-term complications. Among the various treatment modalities available, extension casting has emerged as a promising approach in pediatric forearm fracture management. Objective: The aim was to evaluate the effectiveness of extension casting in reducing the need for repeat interventions in pediatric forearm fractures. Methods: This study was a prospective cohort study conducted at the Department of Orthopaedics &amp; Traumatology of Khwaja Yunus Ali Medical College &amp; Hospital, Enayetpur, Sirajganj, from July 2020 to July 2023. A total of 60 pediatric patients, aged 5-12 years, with acute forearm fractures were enrolled. Different statistical methods were adopted in this study. All analyses were performed using SPSS version 25.0. Results: The study of 60 pediatric patients with forearm fractures showed a mean age of 8.2 years, with 60% males. Most fractures were in the middle third of the forearm (60%). At 12 weeks, 87% maintained satisfactory reduction. Only 10% required repeat interventions. PODCI scores indicated excellent functional recovery, low residual pain, and high satisfaction. Minor complications included skin irritation (6.7%) and transient nerve palsy (3.3%), with no long-term complications. Conclusion: The results of this study affirm the effectiveness and safety of extension casting in managing pediatric forearm fractures. This method not only ensures better maintenance of fracture reduction and reduces the need for repeat interventions but also yields excellent functional outcomes and low complication rates. J Rang Med Col. September 2024; Vol. 9, No. 2: 50-55

Intramedullary osteosynthesis for pediatric forearm re-fractures depending on the time of occurrence

Background Tactical and technical errors in repair of pediatric forearm fractures can be associated with various complications including refractures. There are many questions regarding diagnosis (osteoreparation at the time of the occurrence) and in surgical treatment.The objective was to improve outcomes of pediatic forearm refractures treated with intramedullary osteosynthesis considering a osteoreparation period and the time of the occurrence.Material and methods There were 48 children with forearm refractures treated in the clinic between 2010 and 2020. The patients were divided into two groups. Patients of group 1 (n = 25) were treated with intramedullary osteosynthesis neglecting the regenerative process and the timing of refracture relative to the primary fracture. Patients of group 2 (n = 23) sustained a recurrent fracture at 6 months of early osteoregeneration with developing callosity. Re-fracture occurred in 19 (76.0 %) patients of group 1 including six children (24 %) with two or greater occurrences. Recurrence was observed in 16 (69.6 %) cases of group 2 including seven patients (30.4 %) who sustained more than two fractures.Results The timing of re-fractures, immobilization and gradual removal of fixation components can facilitate improved short- and long-term results of surgical treatment and prevent complications that were evident in 22 (95.6 %) children of group 2 with good results observed at 6 months.Discussion The calluses were replete with blood vessels indicating the normal regeneration for fractures that occurred at 6 months of the initial fracture. No vessels in the callus were seen after 6 months due to resorption of the bundles and poor fracture healing.Conclusion The outcome of re-consolidation would be dependent on the stage of bone regeneration at the time of forearm refracture. The regeneration process was more effective in the early stage of re-fracture.

Evaluating the time to surgery for low severity trauma patients within a trauma quality improvement program.

There is potential for inequity in quality improvement and prevention initiatives of low severity trauma burden may not be considered proportionately in the context of their impacts on healthcare providers or the community. This study defines and tests a small preliminary set of common, low-severity injuries requiring non-urgent, operative interventions in a health region of NZ. The regional trauma registry was reviewed to develop a short list of potential diagnostic groups to be used in testing the time from admission to surgery and selection criteria were applied to find appropriate injuries. The volume of presentations over a 10-year period were analysed. A total of 3213 events with a single injury included in the five selected diagnostic groups met the study selection criteria. The most common (32.4%) diagnostic group was the simple forearm fracture. The supracondylar fracture was the most common (65.9%) group for the 0-14 year olds. The median time delay from arrival to first operative intervention was longest in the tibial fracture group at 45.4 h, and was shortest in the supracondylar fracture group at 10.0 h. Volumes varied between diagnostic groups from an average of 22 per-year for mandibular fractures to an average of 104 per-year for forearm fractures. The results show that the variations in process applied to different diagnostic groups are measurable and can be observed over time. This provides a platform for further work on the quality indicators and benchmarking for delivery of care to patients with low severity trauma.

Fractures of vertebrae and peripheral bones in patients with rheumatoid arthritis (based on long-term observation)

Introduction. In rheumatoid arthritis (RA), fractures occur on average 2–3 times more often than in the general population. Data on the incidence of vertebral fractures in RA is controversial and depends on the detection method. Aim. To determine the incidence of vertebral and peripheral bone fractures in patients with RA during long-term prospective follow-up. Materials and methods. A prospective multi-year cohort non-interventional study included 120 women with RA (mean age at enrollment 54.3±8.9 years), with a follow-up of 9.5±1.9 years. Initially and then repeatedly, a clinical, laboratory and radiological examination was performed: X-ray morphometry of the spine according to the Genant method, X-ray densitometry of the lumbar spine (LI-LIV) and femoral neck. Results. During the follow-up period, there were 104 low-energy fractures in 64 (53%) patients: 69 (66%) vertebral fractures and 35 (34%) peripheral fractures. Two or more fractures occurred in 25 (39%) subjects. In 30 (25%) patients, 52 fractures occurred repeatedly. Among peripheral fractures, the most frequent localization was fractures of the distal forearm and lower leg bones. Patients with fractures during the follow-up period were also more likely to have fractures before enrollment in the study, had an initially longer duration of RA, a mean daily dose, cumulative dose, and duration of glucocorticoid administration, and a lower bone mineral density in the main parts of the skeleton, determined by densitometry. There was no effect of RA activity on DAS-28, rheumatoid factor positivity, or antibodies to cyclic citrullinated peptide on fractures. Conclusion. More than half of the patients had low-energy fractures during the observation period, the most common being fractures of the vertebrae, distal forearm, and lower leg bones; a high frequency of repeated fractures was reported. The analysis of risk factors showed that a long duration of RA, a mean daily dose, cumulative dose, and prolonged use of glucocorticoids, a history of low-energy fractures, and low bone mineral density were associated with the occurrence of fractures in patients with RA.

Removal of Forearm Plate Leads to a Higher Risk of Refracture-A Systematic Review and Meta-Analysis.

Plate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal. We searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable. The total risk difference (RD) was 0.06 (0.04-0.09), indicating that the difference was significant. In the "Reasons for Removal" subgroup analysis, the RD of the "No Symptom" subgroup was 0.07 (95% CI = 0.04-0.11), while the RD of the "Symptoms" subgroup was 0.04 (95% CI = -0.02 to 0.10). In the "Plate Type" subgroup analysis, the RD of the "LCP" subgroup was 0.07 (95% CI = 0.02-0.13), while the RD of the "DCP" subgroup was 0.07 (95% CI = 0.01-0.13). After omitting each study one by one, the RDs were all significant. Plate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant-related symptoms, but more reliable evidence is still needed. The review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared.

The Impact of the COVID-19 Pandemic on the Epidemiology and Management Strategies of Forearm Fractures in Children-a Retrospective Study.

The COVID-19 pandemic has had a considerable influence over the management strategies in pediatric trauma all over the world. We are making a comparative assessment of all pediatric forearm fracture presentations in a tertiary center in Romania in a pre-pandemic year 2019 (NPG) versus a pandemic year 2021 (PG). We retrospectively compared the epidemiological, the anatomopathological, and the management features of forearm fractures for the two years. A total of 1403 patients with forearm fractures, 720 in NPG and 683 in PG, ages < 1 year-19 years (mean for NPG = 9.38 years and mean for PG = 9.39 years), were included in the study. There are no differences in demographics of the patients. There was an increase in the angulation ratio in the PG group and no other differences in the anatomopathological features. Most of the patients were treated by non-surgical means with no differences between groups. In PG, titan elastic nails were more often used than K-wire for the stabilization of diaphyseal fractures. There was no difference in terms of complication rates and reinterventions between groups. The number of hospital admissions (p < 0.01) and the length of hospital stay were significantly higher in NPG versus PG, (p < 0.01). The COVID-19 pandemic has had little impact on the epidemiology, anatomopathological features, and management strategies of forearm fractures in children. The only significant change in the medical strategy in our series was towards reducing the hospitalization rate and duration, reducing the follow-up visits.

Causal association between cholecystectomy and fracture: A Mendelian randomization study.

Previous observational studies have reported that cholecystectomy is associated with an increased risk of fracture. However, the causality of this association remains unclear. This study aimed to explore the causal relationship between cholecystectomy and fracture using a Mendelian randomization (MR) approach. Our primary analytical method was the comprehensive two-sample MR analysis, with inverse variable weighting (IVW) serving as the main analysis technique. In addition, we use Bayesian weighted MR analysis to further confirm the results of IVW method. To enhance the robustness of our findings, we employed multiple analytical approaches including MR-Egger, weighted mode, simple mode, and weighted median. We further conducted sensitivity analyses to validate the stability and feasibility of our dataset. The results of IVW methods showed that there had no significant causal effect of cholecystectomy on fracture (forward P value: .82, .63, .96, .60, .19, .40, .58, .38, .37, .97, and .50 for fracture of wrist and hand, fracture of femur, fracture of foot, fracture of forearm, fracture of lower leg, fracture of lumbar spine and pelvis, fracture of neck, fracture of ribs, fracture of shoulder and upper arm, fracture of skull and facial bones, and fracture of spine), the results of Bayesian weighted MR showed similar results (P > .05). In the reverse, fracture of femur (P = .01) and fracture of shoulder and upper arm (P = .01) showed increased risks of cholecystectomy. The sensitivity analysis showed that none of our analyses were horizontally pleiotropic (P > .05 for MR-Egger's intercept method). Our results do not support the causal effect of cholecystectomy on fracture, which was opposite to most previous observational studies.

The Use of 3-Dimensional Modeling and Printing in Corrective Osteotomies of the Malunited Pediatric Forearm: A Systematic Review and Meta-Analysis.

Forearm fractures contribute up to 40% of all pediatric fractures, with ≤39% of conservatively managed fractures resulting in malunion. Surgical management of malunion is challenging as precise calculation of multiplanar correction is required to obtain optimal outcomes. Advances in 3D computer modeling and printing have shown promising results in orthopaedics, reducing surgical time, blood loss, and fluoroscopy. This systematic review and meta-analysis are the first to explore the accuracy and functional outcome of 3D techniques in pediatric diaphyseal forearm malunion correction. A systematic review was carried out according to PRISMA guidelines. Sixteen studies (44 patients) were included. Average 2D residual deformity was 1.84° (SD=1.68°). The average gain in range of movement (ROM) was 76.08° (SD=41.75°), with a statistically significant difference between osteotomies ≤12 months from injury and >12 months (96.36° vs. 64.91°, P = 0.027). Below a 2D residual deformity of 5.28°, no statistically significant difference on gain of ROM was found, indicating this as a nonconsequential residual deformity (P = 0.778). Multivariate regression analysis showed that 2D residual deformity and time to osteotomy only account for 6.3% gain in ROM, indicating that there are more factors to be researched. This study found superior accuracy of 3D techniques, reporting lower residual deformities than published standard osteotomy data; however, the volume of literature was limited. Larger studies are required to explore additional factors that influence accuracy and ROM, such as 3D residual deformity and the effect of particular 3D printed adjuncts. This will aid clarity in determining superiority and improve cost-effectiveness.

Children’s orthopaedics

The December 2024 Children’s orthopaedics Roundup360 looks at: Establishing best practice for managing idiopathic toe walking in children: a UK consensus; Long-term outcomes of below-elbow casting in paediatric diaphyseal forearm fractures; Residual dysplasia risk persists in developmental dysplasia of the hip patients after Pavlik harness treatment; 3D printing in paediatricorthopaedics: enhancing surgical efficiency and patient outcomes; Pavlik harness treatment for hip dysplasia does not delay motor skill development in children; High prevalence of hip dysplasia found in adolescents with idiopathic scoliosis on routine spine radiographs; Minifragment plates as effective growth modulation for ulnar deformities of the distal radius in children; Long-term success of Chiari pelvic osteotomy in preserving hip function: 30-year follow-up study.