Ulnar Shaft Research Articles

Greenstick fracture of the ulnar shaft following physical therapy in an adult

Rationale:Greenstick fractures most commonly occur in the pediatric population, especially in those under 10 years of age. Greenstick fractures are “extremely” rare in adults. This report presents the case of a greenstick fracture of the ulnar shaft in an adult following physical therapy for a radial neck fracture and ulnar shaft fracture post-internal fixation. Greenstick fracture can occur during physical therapy near the drill holes created during surgery.Patient concerns:A 23-year-old man without any past medical history had sustained a greenstick fracture of the ulnar shaft after rehabilitation for a left radial and ulnar fracture that had been previously treated with internal fixation.Diagnoses:Five months after removal of the implants, the patient complained of left elbow tenderness and a “breaking” sound that occurred during physical therapy. The results of a subsequent X-ray revealed a greenstick fracture of the left ulnar shaft.Interventions:Splinting of the fracture.Outcomes:After 2 months of splint fixation, the pain and range of motion in the affected arm were improved, and sequential X-rays showed callus formation and increased density of the ulnar shaft.Lessons:Greenstick fractures occur not only in children but also in adults in specific circumstances. The cortex of long bones may be further weakened by drill holes created during surgery, and fractures may occur during physical therapy. During treatment, physicians, and therapists should pay more attention to the patient who has undergone implant removal to avoid greenstick fractures, especially in the locations near drill holes.

A Three-Step Method for the Treatment of Radioulnar Synostosis with Posterior Radial Head Dislocation

Congenital radioulnar synostosis with posterior dislocation of the radial head remains challenging to treat. We describe a three-step treatment method that combines radial shaft osteotomy with a custom-made device, ulnar shaft osteotomy, and local adipofascial flap elevation procedures. For posterior radial head dislocation treatment, osteotomy near the proximal radius cannot recover physiological rotation of the radial head. Thus, we chose a precise radial shaft osteotomy with a custom-made device according to preoperative planning based on three-dimensional evaluation of the bone deformation. Performing radial shaft osteotomy alone, however, may not be enough to achieve sufficient supination range of motion. We, therefore, also performed ulnar shaft osteotomy. Finally, we elevated the local adipofascial flap to prevent re-adhesion. In three patients, the range of motion of the elbow improved postoperatively. In conclusion, our three-step method does not require a microsurgical technique and is easy to perform.

Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review

BackgroundAtypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy.Case presentationAn 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery.ConclusionsBased on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.

Comparison of Bending Strength among Plate, Steinmann Pin, and Headless Compression Screw Fixations for Proximal Ulnar Shaft Fracture in Sawbones

Purpose: Although plate osteosynthesis is commonly used to treat proximal ulna fracture, its treatment method is controversial because of complications such as large incision, long operation time, and soft tissue injury. Therefore, intramedullary headless compression screw (HCS) and Steinmann pin are considered as alternative treatment options. In this study, we aim to compare bending strength of plate and cortical screws, HCS, and Steinmann pin for proximal ulnar shaft fracture with sawbone. Methods: Transverse type fractures were made intentionally at the distal 7 cm from the proximal end of ulna sawbones and fixated with plate, HCS, and Steinmann pin after reduction. Three-point bending tests were performed with total of 21 sawbones, seven pieces for each group. Results: Average ultimate bending strength for each group was as follows; 521.7N for plate fixation group, 706.4N for HCS fixation group, and 812.6N for Steinmann pin fixation group. Statistically significant results were observed among the three groups (p<0.01). When two groups were compared separately, Steinmann pin fixation and plate fixation (p<0.01), Steinmann pin and HCS fixation (p=0.047) showed statistical significance. There was a significant trend between HCS and plate fixation group (p=0.064).Conclusion: HCS and Steinmann pin fixation showed higher bending strength when compared to plate fixation for proximal ulnar shaft fracture in sawbone. Although further studies are needed, HCS and Steinmann pin fixation are promising fixation methods that may be used as an alternative to plate fixation.

Ulnar shaft stress fractures in fast-pitch softball pitchers: a case series and proposed mechanism of injury.

Stress fractures of the upper extremities in athletes are important injuries for radiologists to appreciate despite being far less common than stress fracturesof the lower extremities. Among upper extremity stress fractures, those involving the olecranon have been well described in overhead pitching athletes. Isolated stressfractures of the ulnar shaft however are less commonly reported in the literature and considered to be rare. We have observed a correlation between young patients withulnar shaft stress fractures and the activity of fast-pitch softball pitching. In this series, we present the imaging findings in four cases of ulnar shaft stressfractures in softball pitchers who presented with insidious onset forearm pain. Furthermore, a review of the literature focusing on softball pitching mechanics isprovided to offer a potential underlying mechanism for the occurrence and location of these injuries. An awareness of the imaging appearance of ulnarshaft stress fractures along with an understanding of its proposed mechanism will facilitate accurate and timely imaging diagnosis of this injury by the radiologist.

Ipsilateral shoulder and elbow dislocation: Camel bite-related injury

Ipsilateral dislocation of the shoulder and elbow joints is a quite rare injury. Due to its rare presentation, one of the two-dislocation diagnoses can be delayed or even missed. We present a unique case of camel-bite injury, resulting in ipsilateral shoulder and elbow fracture dislocation with open ulna shaft fracture that has not been reported in the English literature before. Camel-bites injuries should be taken seriously as it can result in severe, devastating open injuries. The gripped extremity should raise the suspicion of multiple injuries, so careful assessment of the entire extremity should be carried out. Moreover, proper surgical and medical management can prevent unpleasant outcomes.

Percutaneous Plate Osteosynthesis of Ulnar Shaft Fractures: A Surgical Technique and Case Series.

Treatment of ulnar diaphyseal fractures can range broadly from nonoperative with immobilization to surgical intervention with a variety of implants or approaches. At a Level 1 trauma center, a series of ulnar shaft fractures have been treated using a percutaneous plating technique that is base beneath the extensor carpi ulnaris. This technique description illustrates relevant anatomy, important patient and injury characteristics, implant considerations, and potential outcomes and complications. The described treatment option provides an effective way of spanning comminuted fracture patterns without disrupting the surrounding biology while providing stable fixation. An associated patient series is included which enumerates associated injuries and describes limited follow-up. In the multiply injured trauma patient, such a fixation method also had potential benefits for their overall care and rehabilitation.

Bridge Plating for Comminuted Ulna Fractures.

Highly comminuted fractures of the forearm are challenging for orthopaedic surgeons to manage because of the functional importance of anatomic restoration of alignment while obtaining sufficient fixation. The use of spanning plate fixation to stabilize comminuted ulna shaft fractures allows the patient early range of motion, whereas maintaining appropriate alignment and maximizing the patient's chances for a good outcome. This video demonstrates a technique for treating a highly comminuted open forearm fracture using spanning or bridge plating techniques.

An atypical type of monteggia equivalent: A case report

Monteggia fracture dislocations comprise about 5-10 % of all forearm fractures in adults and was first described in 1814. Since then there has been many descriptions of Monteggia equivalents. We present a case of 33 year old female with fracture of diaphysis of ulna with fracture shaft of radius proximal 1/3rd with posterior radial head dislocation managed by open reduction and internal fixation of both radius and ulna by LCDCP and screws with reduction of radial head and its functional outcome.

Elbow Pain - CrossFit

HISTORY: A 29-year-old male CrossFit and surfing instructor with a history of left ulnar shaft fracture treated nonoperatively presented with a 9 month duration of chronic, intermittent, left, sharp and burning elbow pain since injuring himself weight lifting. Bicep flexion and thumb rotation caused pain radiating to the elbow. He endorsed numbness of the left hand that led to an ER visit 9 months ago. His tingling resolved prior to our visit and he denied shoulder or neck pain. He has been seen previously by a Hand Specialist, was offered a steroid injection, and presented to us for further evaluation. PHYSICAL EXAMINATION: The patient exhibited no obvious atrophy of the forearm, but trace atrophy at the left medial triceps. He had full flexion and extension equal bilaterally, with slightly decreased supination on the left as compared to the right side. He was tender to palpation over the distal biceps, but nontender in the antecubital fossa. There was mild crepitus with resisted supination and pronation on the lateral epicondylar region. Radial head was minimally tender to palpation. He had elbow pain with resisted elbow flexion in neutral and supination more so than pronation. No skin changes were appreciated and no obvious elbow effusion. Distal neurovascular exam was grossly intact. DIFFERENTIAL DIAGNOSIS: 1. Distal biceps tear 2. Bicipitoradial bursitis 3. Ulnar shaft fracture 4. Radial head fracture 5. Osteochondritis dissecans of the capitulum TEST AND RESULTS: Elbow MR arthrogram (obtained 3 weeks ago) demonstrated a very small partial thickness tear of the ulnar collateral ligament, minimal radial cartilage loss, and a partial thickness tear of the distal biceps with prominent bicipitoradial bursitis. FINAL/WORKING DIAGNOSIS: Left partial thickness distal biceps tear AND associated bicipitoradial bursitis TREATMENT AND OUTCOMES: 1. Patient elected to avoid steroid injections and pursue conservative management involving physical therapy and topical NSAIDs 2. Pain continued intermittently. Further work up 1 year later included CT elbow showing mild left ulnohumeral joint osteoarthritis with small ossific joint loose bodies and healed proximal left ulna shaft and coronoid process fractures 3. Elbow pain may be subsequent to malalignment from an old Monteggia fracture

Computer tomographic analysis of anatomic characteristics of the ulna - essential parameters for preshaped implants.

PurposeAnatomically preshaped implants are needed for exact restoration of the anatomy after fractures of the proximal ulna and ulnar shaft, which enables a good functional outcome. Aim of this computed tomographic analysis was to identify specific characteristics of the ulna. The data serve for the development of a new intramedullary implant for stabilisation of proximal and diaphyseal ulna fractures.MethodsWith a standardized research method 100 CT scans of the ulna were evaluated regarding anatomic parameters like width of the medullary canal, proximal ulna dorsal angulation and varus angulation. Also, correlations of these parameters were analyzed statistically.ResultsThe mean proximal ulna dorsal angulation (PUDA) was 6.4° (SD 2.8°), while the mean varus angulation of the proximal ulna was 12.4° (SD 3.3°). The length of the ulna bone was 253.6 mm (SD 19.9 mm) on average. The average minimum diameter of the medullary canal was 4.2 mm (SD 1.1 mm) located at 141.3 mm (SD 19.7 mm) from the olecranon tip. There is a positive correlation between age and minimum diameter in our patient cohort (p< 0.001).ConclusionOur study described the anatomy of the proximal ulna and the ulna shaft with a reproducible research method in a representative patient cohort. The knowledge of the evaluated anatomic parameters can lead to an improvement of any implant design for the fixation of proximal and diaphyseal ulna fractures.

Anatomy of the posterior branch of the medial antebrachial cutaneous nerve: A cadaveric study

PurposeThe posterior branch of the medial antebrachial cutaneous nerve (MACN) is at risk to be damaged during cubital tunnel surgery. The purpose of this study was to identify the location of the posterior branch of the MACN (PBMACN) in relation to surgical landmarks pertinent in cubital tunnel surgery. MethodsWe performed an anatomical study on 20 limbs from 13 fresh cadavers. The nerve was dissected from 10cm proximal to 10cm distal of the medial epicondyle. We measured the distance between the nerve and the medial epicondyle, and also the distance separating the PBMACN from the ulnar nerve passage between the two heads of the flexor carpi ulnaris. Measurements were performed with the elbow at 45° and 90° of flexion, as well as in full pronation and supination. ResultsAfter its emergence from the main trunk of the MACN, the posterior branch ran anteriorly to the medial epicondyle, taking an oblique direction toward the ulnar shaft. The PBMACN was in average 2.53cm under the medial epicondyle when the elbow was flexed at 45°, and 2.96cm when the elbow was flexed at 90°. Average distance between the PBMACN and the penetrating point of the ulnar nerve within the flexor carpi ulnaris was 1.54cm when the elbow was flexed at 45°, and 1.62cm when the elbow was flexed at 90°. Pronation and supination positions of the forearm did not significantly modify our measurements. ConclusionsUnderstanding the position of MACN posterior branch during ulnar nerve release surgery at the elbow may help in preventing iatrogenic injury. According to our measurements, incision and superficial dissection anterior to the medial epicondyle or distal to the ulnar nerve penetrating point between the two heads of the flexor carpi ulnaris should be avoided or done with an elbow flexed at 90°.

Nailing of diaphyseal ulna fractures in adults\u2014biomechanical evaluation of a novel implant in comparison with locked plating

BackgroundAdult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect.MethodsTen pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization methods.ResultsThe nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs (0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001).ConclusionsIntramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not present in stiffer constructs.

Percutaneous leverage technique for reduction of radial neck fractures in children: technical tips.

PurposePaediatric radial neck fractures are challenging to treat. Multiple strategies exist for reduction and fixation; there is no clear consensus on the best surgical technique to achieve reduction. The percutaneous leverage technique is a method for reduction of radial neck fractures that has previously been described by Wallace, though there is a lack of published literature on this technique. We present a technical note and a modest case series on our modification to the percutaneous leverage technique accompanied by intramedullary fixation.MethodsWe describe a retrospective series of patients who underwent the modified percutaneous leverage technique for paediatric radial neck fracture reduction followed by flexible intramedullary nail fixation at a single Level I trauma centre from 2008 to 2016. This technique involves making a small incision over the dorsal border of the ulna and using a blunt curved surgical forceps to dissect towards the ulnar border of the radius just distal to the radial neck fracture site. The curved forceps is then used to push the radial shaft away from the ulnar shaft which reduces the radial neck fracture. Intramedullary fixation is then utilized to stabilize the reduction. Pre- and postoperative radiographs and clinical data from the medical record were reviewed, and patient, injury and treatment characteristics as well as complication rates are summarized.ResultsWe successfully treated a series of eight radial neck fractures with the modified percutaneous leverage technique. This technique allows for a small incision and a minimally invasive method for the reduction of paediatric radial neck fractures. This allowed for subsequent intramedullary fixation and early postoperative elbow mobilization. In our series, no patients developed synostoses or sustained peripheral nerve injuries using this technique.ConclusionThe modified percutaneous leverage technique followed by intramedullary fixation is a safe and effective technique for fixation of displaced paediatric radial neck fractures.Level of EvidenceLevel IV

Trends in fracture development of the upper extremity in Germany\u2014a population-based description of the past 15\u2009years

BackgroundRecent studies investigating fracture development in Germany are not available especially with regard to demographic change. The primary aim of this study was to report trends in fracture development of the upper extremity in Germany between 2002 and 2017 and to evaluate changes over time.MethodsEvaluating inpatient data from the German National Hospital Discharge Registry (International Classification of Diseases, ICD-10) between 2002 and 2017. Total count, incidences and percentage changes of the following fracture localizations were analysed: proximal humerus, distal humerus, proximal ulna, proximal radius, ulna diaphysis (including Monteggia lesion) and distal radius. Ten age groups for men and women were formed: 35–44, 45–54, 55–64, 65–74; 75–84; 85–90, and > 90 (years).ResultsThe total count of proximal humeral fractures increased from 40,839 (2002, men/women 9967/30,872) to 59,545 (2017, men/women 14,484/45,061). Distal humeral fractures increased from 5912 (2002, men/women 1559/4353) to 6493 (2017, men/women1840/4653). The total count of forearm fractures increased from 68,636 (2002, men/women 17,186/51,450) to 89,040 (2017, men/women 20,185/68,855). Women were affected in 70–75% of all cases with rising incidences among nearly every age group in female patients.ConclusionTotal count of nearly every evaluated fracture increased. Also, incidences increased especially in the older female age groups. Fracture development already seems to reflect demographic changes in Germany.

Fractures of the radius and ulna in adults: An analysis of factors affecting outcome

Authors in group collected the data for fracture of the shaft of radius and ulna in 80 adult patients. Study Period: 1st October 2014-1st October 2017 The aim of the study was to determine relationship of the subjective, objective and radiographic method of treatment. The type of fractures, both open and closed, grade of communition and other injuries were assessed in patients in term of degree of pain, rotation of forearm and return to the same work following injury and the patients treated with ORIF and plate fixation were having better result in all aspect assessed than closed reduction and plaster cast. Factor most often associated with return to same work after injury are better with ORIF (Open reduction and internal fixation). Longer time for union and higher rate of infection were the only disadvantages of ORIF over closed reduction, otherwise outcomes were same for both the methods. Presence of other injuries often compromise the end result because of more pain , greater forearm rotation loss and decline in return to same work. The satisfaction and work status in assessment of outcome, concept of functional malunion, interpretation of radiographic finding should help in counselling the patient as to economic and functional impact of these injuries. Keywords: Fracture radius-ulna open reduction with plate fixation, Closed reduction with nailing.

Hydatid cyst disease in children: 10-years experience at two tertiary centers from Northeast Anatolia of Turkey

Aim: Hydatid cyst remains a significant health problem in endemic regions such as Turkey. It can be observed at any age, but the diagnosis is usually made at adulthood. The aim of this study was to investigate the epidemiological findings of hydatid cyst cases in the pediatric age group in Turkey. Material and Methods: The records of the patients who received the diagnosis of hydatid cyst in the pathology departments of Ataturk University Faculty of Medicine and Erzurum Regional Training and Research Hospital between 2009–2019 were analyzed retrospectively. Data such as age, sex, location, size and number of cysts of the cases diagnosed with hydatid cyst between 0–16 years of age were analyzed statisticall.Results: Of the 1072 cases diagnosed with hydatid cyst, 32.7% (n=351) were within the age range of 0–16 years, 57.8% (n=203) were male and 42.2% (n=148) were female, with a mean age of 10.8 years (SD: ± 3.5; min: 1, max: 16). In 86.3% (n=303) of the cases, the cyst was found to be located in a single organ, whereas it was located in two different organs in 13.7% (n=48) of the cases. Involvement of the liver and lung was observed in 54.4% (n=191) and 50.4% (n=177) of the cases, respectively. Less involvement was observed in brain (n=10), kidney (n=9), spleen (n=5), retroperitoneal region (n=4), omentum (n=2), nasal cavity (n=1), thoracolumbar region (n=1), tail of the pancreas (n=1) and ulna diaphysis (n=1). In all cases, the mean cyst size was measured to be 7.4 cm (SD: ± 2.9; min: 1.5, max: 17) based on the largest cyst size.Conclusion: Hydatid cyst is also common in the pediatric age group. Hydatid cyst has been found to be more common in males in the pediatric age group in Turkey, with its most common localization being in the liver and lung.

New forelimb long bone specimens of &lt;i&gt;Nacholapithecus kerioi&lt;/i&gt; from the Middle Miocene of northern Kenya

This article reports eight new humeral, ulnar, and radial fragments of Nacholapithecus kerioi collected from Nachola, Kenya during the 1998/1999 field seasons. The study refines the description of its forelimb bones, which was mostly based on a single partial skeleton. The most distinctive feature of the distal humerus is a large, globular, medially tilted capitulum. The groove between the capitulum and the zona conoidea is quite deep. The medial part of the humeral trochlea is also diagnostic in showing a less salient medial border. The medial epicondyle is moderately long and more posteriorly reflected than was previously presumed. The coronoid process of the ulna is quite wide. Its medial portion is distinctly concave. The ulnar shaft is anteroposteriorly deep in its proximal half, slender, straight in frontal view, and weakly anteriorly bowing. The elbow of Nacholapithecus exhibits a primitive functional pattern as a hominoid, including lack of universal stability of the humeroulnar joint through full extension and flexion, restriction of hyperextension of the elbow, and relatively anteroposteriorly oriented loading at the proximal ulna. On the other hand, it is derived in terms of enhanced rotational mobility and stability of the radius, incipiently increased stability at the humeroulnar joint, and more frequent maximum extension of the elbow compared to proconsulids. This mosaic morphology is different from both early Miocene proconsulids and later suspensory or orthograde European fossil apes. Although Nacholapithecus was neither suspensory nor orthograde, its forelimbs may have played a greater role for body support or balance maintenance, more frequently reaching to and exploiting overhead supports than in early Miocene proconsulids.

Ulnar nerve palsy following a closed fracture of shaft of radius and ulna in a child

Ulnar nerve paly is a rare condition after closed fractures of the radius and ulna. It can present as neuropraxia mostly, but nerve entrapment and laceration should also be kept in mind. The authors present a case of a 14-year-old boy who developed ulnar nerve palsy following a left radius and ulna midshaft fracture with significant angulation and displacement. Intra-operatively, the ulnar nerve was found trapped on a spike of the ulna. At 20 weeks follow up, the patient had a complete recovery from the ulnar nerve palsy. It is important to evaluate the patient properly before any procedure or manipulation and manage according to the type of lesion.

Change in paediatric upper extremity fracture incidences in German hospitals from 2002 to 2017: an epidemiological study.

Recent studies investigating the frequency of paediatric fractures in Germany are not available. The primary aim of this study was to report frequencies of the most common paediatric upper extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time. This study used inpatient data from the German National Hospital Discharge Registry. Absolute frequencies and incidences of the following fracture localisations were analysed: clavicle, proximal humerus, humerus shaft, distal humerus, ulna shaft, radius shaft, forearm shaft, distal radius, and distal forearm. Four age groups were formed: 0-4, 5-9, 10-14, and 15-19years. The boy-girl ratio (BGR) was calculated for all fracture localisations for both years, respectively. Incidence rate ratios (IRRs) were calculated to compare fracture incidences between 2002 and 2017. The absolute number of the nine fracture localisations together decreased from 38,480 in 2002 to 35,128 in 2017. The overall BGR was 2.0 in both years. The BGR increased with increasing patient age. The incidence of clavicle fractures increased from 2002 to 2017 (IRR ≥ 1.72), while that of humerus fractures (proximal, shaft, and distal) remained the same or decreased (IRR ≤ 1.00) within all age groups. The incidence of isolated ulna or radius shaft fractures increased slightly or remained the same in the two lower age groups (IRR ≥ 1.00), while it decreased in the two higher age groups (IRR ≤ 0.80). Furthermore, complete forearm fractures were more frequent in the 0-4, 5-9, and 10-14year age groups (IRR ≥ 1.44) in 2017 compared to 2002. The incidence of distal radius und forearm fractures changed only slightly. The absolute number of paediatric upper extremity fractures decreased from 2002 to 2017, while the incidence of in-hospital treatment of clavicle and forearm fractures increased significantly, indicating a trend towards operative treatment.