Treatment Of Distal Forearm Fractures Research Articles

Prospective Comparative Study of Above Elbow Cast for Six Weeks Versus Above Elbow Converted to Below Elbow Cast After Three Weeks for Pediatrics Distal Forearm Fracture

IntroductionForearm fractures are common injuries and the approach to manage these in children is different than similar injuries in adults. Various methods of cast immobilization are done for the treatment of distal forearm fractures in children. The purpose of this study was to determine if above elbow cast (AEC) converted to below elbow cast (BEC) in three weeks are as effective as above elbow cast (AEC) in the treatment of the distal forearm fracture. Therefore, this study was conducted with the objective of evaluating and comparing the outcome of above elbow cast (AEC) with above elbow converted to below elbow cast (BEC) after three weeks for management of pediatrics distal forearm fracture. MethodsThis study was conducted in Department of Orthopedic Surgery in College of Medical Sciences-TH Bharatpur, Nepal from February 2016 to January 2017. Among sixty cases thirty were selected in AEC group and thirty in above elbow converted to below elbow cast group (AEC/BEC) by simple random sampling. All patients were followed up six months. ResultsOut of sixty patients in two groups, fifty-three made to all follow up. Twenty- eight of cases were AEC group and twenty-five were AEC/BEC group. All the cases had union at six weeks and twelve weeks follow up. There was statistically significant difference in limitation in pronation/supination. Conclusions AEC converted to BEC for six weeks is effective as AEC for six weeks in the treatment of distal third forearm fracture in children. AEC/BEC group patients have lesser degree of loss of supination/pronation movement.

Operative versus conservative treatment of distal forearm fractures in pediatric age group between (6 to10) years old

Operative versus conservative treatment of distal forearm fractures in pediatric age group between (6 to10) years old

Functional outcome of long-arm cast versus double sugartong splint in acute paediatric distal forearm fractures: A randomised controlled trial

Background: The treatment of choice for paediatric distal forearm fractures has been a long-arm cast (LAC) following closed reduction. An alternative treatment is to use a double sugar-tong splint (DSTS), found equally effective to provide three-point fixation and comparable outcomes to cast. Objectives: To compare the functional outcome between LAC and DSTS for the treatment of paediatric distal forearm fractures. Methods: A randomised controlled trial was done among 36 patients of 5-15 years with acute distal forearm fractures without neurovascular deficit treated with LAC and DSTS recruited by convenience sampling at a tertiary care centre after ethical approval. Acceptability of reduction, loss of reduction, union rates, cast comfort, range of motion and complications were studied at follow-up upto 12 weeks and analysed using SPSS v.11.5. Results: Among a total of 36 patients, 18 cases were treated by the LAC method and others by the DSTS method. Both LAC and DSTS were comparable in the maintenance of reduction, the remanipulation rate was 8.3% (n = 3), not significant (p-value = 0.967). All had a union at six weeks follow-up. No statistical difference in mean VAS score (p-value = 0.524), mean loss of flexion (p-value = 0.397), and mean loss of pronation/supination (p-value = 0.814). No statistically significant difference in activities of daily living was noted. No complications were encountered. Conclusion: DSTS is safe and as effective as LAC in the treatment of distal forearm fractures in children, identical in terms of functional outcome, maintenance of reduction, complications, and time to union.

A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures

BackgroundDistal forearm fractures are a commonly encountered injury in the emergency department (ED), accounting for 500,000 to 1.5 million visits and 17% of ED fractures. The evaluation and management of these fractures frequently employs x-ray studies, conscious sedation, closed reduction, and splinting. Point-of-care ultrasound (POCUS) can offer significant benefit in the diagnosis and management of these common injuries. Objective of the ReviewTo review the clinical utility of POCUS in the diagnosis of distal forearm fractures, as well as to demonstrate the performance of ultrasound-guided analgesia delivery and ultrasound-guided reduction technique. DiscussionThe initial evaluation of forearm injuries frequently includes x-ray studies. However, multiple studies have shown ultrasound to be sensitive and specific for distal radius fractures, with the added value of detecting soft tissue injuries missed by conventional radiography. POCUS may also facilitate analgesia through the use of ultrasound-guided hematoma blocks, which removes the need for conscious sedation prior to manipulation. Finally, POCUS can be used after manipulation to assess cortical realignment of the bone fragments and spare the patient multiple reduction attempts and repeat radiographs. ConclusionDistal forearm fractures are common, and the emergency physician should be adept with the evaluation and management of these injuries. POCUS can be a reliable modality in the detection of these fractures and can be used to facilitate analgesia and augment success of reduction attempts. These techniques may decrease length of stay, improve patient pain, and decrease reduction attempts.

Redisplacement of paediatric distal radius fractures: what is the problem?

PurposeDistal radius fractures represent one of the most common fractures in children. Our purpose is to analyze risk factors for redisplacement in children with distal radius fractures treated by means of closed reduction and plaster cast immobilization.MethodsRetrospective study, including children under the age of 17 years, who underwent closed manipulation and cast immobilization for a distal third radius fracture, between 2012 and 2015. Preoperative radiographs were reviewed for initial translation, angulation and shortening, distance of the fracture from the physis, degree of fracture obliquity and the presence of an ulna fracture. Postoperative radiographs were analyzed for translation, angulation and shortening, as well as the quality of closed reduction. Cast index, gap index and three-point index, were measured on the postoperative radiographs. Redisplacement and re-intervention during follow-up were registered.ResultsA total of 26 patients were included in this study. Comparison between post-reduction and immediate post-cast removal radiographs did not show any statistically significant difference between translation or shortening. Coronal (p = 0.002) and sagittal (p = 0.002) angulation showed a statistically significant difference, but both median values remained below cut-off values for redisplacement. Redisplacement was observed in four patients. Only one patient underwent remanipulation. All four had full remodelling and proper radiological alignment at final follow-up. Quality of reduction was found to be a statistically significant risk factor for redisplacement (p = 0.013).ConclusionClosed reduction and cast immobilization under general anaesthesia yields good results in the treatment of distal forearm fractures in paediatric patients. Quality of reduction was the only risk factor that we found to be predictive of redisplacement.Level of Evidence:Level III – Retrospective comparative study

Treatment of Distal Forearm Fractures in Children.

Distal forearm is the most common fracture location in the growing skeleton. The aim of this article is to describe the current practice of these fractures. Case series accompanied by experts' opinion. Most of these injuries are benign incomplete distal metaphyseal torus fractures best treated with a dorsal below elbow splint for 2-3 weeks with no follow-up. Completely displaced metaphyseal fractures in prepubertal children can be either immobilized in bayonet position after axial alignment or fixed with K-wires after reduction. Complete fractures of distal metaphysis in adolescents should heal in near anatomic alignment because remodeling is uncertain. We advocate reduction of most greenstick and complete fractures at the distal metaphyseal diaphyseal junction and radiographic follow-up to monitor fracture alignment. Physeal fractures in adolescents and intra-articular fractures in children of all ages should be anatomically reduced. We perform most of our osteosyntheses with K-wires.

X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture.

Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

Special aspects of fractures of the distal forearm

Fractures of the distal forearm, especially fractures of the distal radius which are the most common fracture in humans, are of increasing socioeconomic relevance due to the increasing incidence and the increasing costs that are associated with the popularity of palmar plating. Radiological imaging for diagnosis and follow-up are presented with special focus on new biomechanical fracture concepts such as the four-corner concept. The basic literature and expert opinions are evaluated and discussed. In intra-articular fractures of the distal radius, plain radiographs must be supplemented by computed tomography (CT). Direct CT arthrography allows not only analysis of the fracture pattern, but also detection of accompanying injuries of the carpus, especially the scapholunate ligament, and the ulnocarpal complex. The plain radiographs should also be analyzed for accompanying injuries. Therefore, both acquisition of the imaging data and their morphometrical analysis have to be standardized. In addition to diagnosis and follow-up, radiological imaging plays adecisive role in the treatment of distal forearm fractures. CT and direct CT arthrography have become important tools in intra-articular distal radius fractures.

Body Mass Index does not affect Cast Index but increases risk of complication associated with treatment of distal forearm fractures

Purpose: Approximately 20% of all pediatric fractures are distal forearm fractures, most of which are treated non-operatively with closed reduction and casting. Reduction is maintained by a well-molded cast. It is unclear if the amount of soft tissue surrounding a fracture may affect the ability to achieve a good cast mold. The aim of this study was to evaluate the impact of body mass index (BMI) on cast index (CI) and complications in pediatric patients with distal forearm fractures. …

Body Mass Index does not affect Cast Index but increases risk of complication associated with treatment of distal forearm fractures

Body Mass Index does not affect Cast Index but increases risk of complication associated with treatment of distal forearm fractures

Healthcare Disparities in the Treatment of Pediatric Distal Radius-Ulna Fractures: A Single-Institution Perspective

Background: This study sought to identify variables associated with socioeconomic disparities in the treatment of distal forearm fractures in children. Methods: A single-institution retrospective cohort study of patients less than 18 years of age with isolated fractures of the distal radius and ulna. Patient included underwent a closed reduction and casting under sedation by an orthopedic resident with outpatient, clinical follow up within two weeks of injury. Demographic data were collected. Primary outcomes evaluated were the final fracture alignment and rate of surgical treatment. Results: 177 children included in this study, including 105 with private insurance and 72 with Medicaid or no insurance, 129 were white and 48 were minorities, and 51 were female while 126 were male. There were no statistically significant differences between patient groups when assessed for treatment outcome, mean fracture displacement, time to first clinic appointment, and duration of follow-up. Rates of surgical treatment between all groups tested were non-significant. Of patients that met institutional operative criteria, a lower percentage of non-white (p=0.03), male (p=0.07), and non-private insurance patients (p=0.08) received surgery when surgery was indicated compared to white female patients with insurance. Conclusions: At a single institution, no clear disparities in the overall care and outcomes of children with distal radius and ulna fractures were identified. When surgery was indicated by institutional standards, a significantly greater percentage of white patients underwent surgery when compared to non-whites, but no significant difference in the percentage of good, fair, and poor outcomes between these groups was seen.

DISTAL RADIAL AND ULNAR LANDMARKS USED IN PERCUTANEOUS PIN FIXATION: ANATOMICAL RELATIONSHIP TO THE SUPERFICIAL RADIAL AND ULNAR NERVES

The radial and ulnar styloids as well as Lister's tubercle are important surgical landmarks in the surgical treatment of distal forearm fractures. There have been limited studies assessing their relative safety in terms of their distance from superficial nerves which are in danger during surgical procedures. The aim of this cadaveric study was to assess and compare the distance of superficial nerves to these important surgical landmarks. Twenty embalmed cadaveric upper limbs were dissected exposing the nerves and tendons around the wrist. The radial styloid, Lister's tubercle, ulnar styloid and nerve branches were marked with pins. The distance of the nearest nerve branch to each landmark was measured with a digital calliper. Statistical analysis of the data was performed using SPSS for Windows 11.5 (SPSS Inc., Chicago, IL) using Friedman Tests and Wilcoxon Signed Ranks tests. The median distance of the nearest nerve branch to the radial styloid was 5.42 mm, to the Lister's tubercle was 16.68 mm and to the ulnar styloid was 13.56 mm. There was unequal safety for these three surgical landmarks regarding proximity to nerve branches (p < 0.00001). Paired comparison using Wilcoxon Signed Ranks Test showed that the Lister's tubercle was safer than the radial styloid (p < 0.0001) and ulnar styloid (p = 0.04). In addition, the ulnar styloid was safer than the radial styloid (p < 0.001). There is a higher risk of injury to superficial nerves when operating near the radial styloid as it is significantly closer to nerve branches as compared to Lister's tubercle and ulnar styloid.

Comparison of Short and Long Arm Plaster Casts for Displaced Fractures in the Distal Third of the Forearm in Children

Various methods of cast immobilization have been recommended for the treatment of distal forearm fractures in children. The purpose of this study was to determine if short arm casts are as effective as long arm casts in the treatment of displaced fractures of the distal third of the forearm in these patients. In a prospective randomized trial, consecutive patients, four years of age or older, who presented to The Women's and Children's Hospital of Buffalo with a displaced fracture of the distal third of the forearm were randomized to treatment with a short or long arm plaster cast. Radiographs were analyzed for displacement, angulation, and deviation at the time of injury, after reduction, and at subsequent follow-up intervals. The cast index at the fracture level, used to assess the quality of the cast molding, was determined from the postreduction radiographs. Changes between postreduction and final values for displacement, angulation, and deviation; the ranges of motion of both wrists and elbows; the need for physical therapy; and responses to a questionnaire used to evaluate the effects of the cast on activities of daily living were compared between the groups. One hundred and thirteen of the 151 patients who were assessed for eligibility were analyzed. The follow-up rate was 92%, and the average duration of follow-up was eight months. Sixty long arm casts and fifty-three short arm casts were used. There were no significant differences between the two groups with regard to patient demographics, initial fracture characteristics, mechanism of injury, cast index, or the change in displacement, angulation, or deviation during treatment. The fractures that lost reduction in the cast had significantly higher cast indices, indicating poor cast-molding. A comparison of partially and completely displaced fractures revealed no difference between the groups with regard to the change between the postreduction and final amount of displacement. Patients treated with a short arm cast missed fewer school days and were less likely to require assistance with various activities of daily living. A well-molded short arm cast can be used as effectively as a long arm cast to treat fractures of the distal third of the forearm in children four years of age and older, and they interfere less with daily activities.