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Topic:

Forearm Shaft Fracture

Issue:

Forearm

Category:

Trauma

Title:

Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures

Author:

Syed, Akbar Nawaz MD; Ashebo, Leta BA; Lawrence, J. Todd R. MD, PhD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p e124-e130, DOI: 10.1097/BPO.0000000000002552

Level Of Evidence:

III

# of Patients:

402

Study Type:

Retrospective chart review

Location:

Single tertiary care institution

Summary:

This study aims to evaluate the refracture rate in pediatric patients following operative treatment of both bone forearm fractures based on the mode of fixation (intramedullary nails vs. plate fixation).

Methods:

Patients were stratified by the initial operative fixation type: both bones fixed with nails, one bone fixed with a nail, both bones plated, and one bone plated. The study reviewed refractures following initial operative treatment, with statistical analysis using the χ2 test and Fisher’s exact test.

Exclusions:

Not specified

Results:

Age and Refracture Rate: Patients aged ≤10 years had a significantly higher refracture rate than those >10 years (12.5% vs. 2.5%, P<0.001). Intramedullary Fixation: 61.3% had both bones treated, and 38.7% had single bone fixation. Refractures occurred in 15 patients, with 11 refractures in the single bone fixation group (11.1%) and 4 in the both bones fixation group (2.5%). Plate Fixation: 84.4% had both bones fixed, and 15.8% had single bone fixation. Refractures occurred in 7 patients, with 6 in the both bones fixation group (4.9%) and 1 in the single bone fixation group (4.3%). Refracture Comparison: Single bone fixations had significantly higher refracture rates compared to both bone intramedullary nail fixation (11.1% vs. 2.5%, P=0.006). Single bone ulna fixations also had a higher refracture rate compared to both bone fixations (12.1% vs. 3.6%, P=0.003).

Conclusions:

The overall refracture rate following operative treatment of both bone forearm fractures was 5.5%, with no significant difference between intramedullary and plate fixation techniques. Patients aged ≤10 years had a higher refracture rate. Single bone fixations, particularly in the radius or ulna, had higher refracture rates. To reduce refracture rates, surgeons should consider performing intramedullary fixation of both bones and emphasize effective postoperative counseling, particularly for younger patients.

Relevance:

Limitations:

Perspective:

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