Conflict of interests: the authors declare no potential conflict of interests. Vopat et al. This article has been cited by other articles in PMC. Abstract Both bone forearm fractures are common orthopedic injuries. Optimal treatment is dictated not only by fracture characteristics but also patient age.
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Conflict of interests: the authors declare no potential conflict of interests. Vopat et al. This article has been cited by other articles in PMC. Abstract Both bone forearm fractures are common orthopedic injuries.
Optimal treatment is dictated not only by fracture characteristics but also patient age. Generally, these fractures can be successfully managed with closed reduction and casting, however operative fixation may also be required.
The optimal method of fixation has not been clearly established. Currently, the most common operative interventions are open reduction with plate fixation versus closed or open reduction with intramedullary fixation. Plating has advantages of being more familiar to many surgeons, being theoretically superior in the ability to restore radial bow, and providing the possibility of hardware retention.
Recently, intramedullary nailing has been gaining popularity due to decreased soft tissue dissection; however, a second operation is needed for hardware removal generally 6 months after the index procedure. Current literature has not established the superiority of one surgical method over the other.
The goal of this manuscript is to review the current literature on the treatment of pediatric forearm fractures and provide clinical recommendations for optimal treatment, focusing specifically on children ages years old.
Historically, the majority of these fractures have been treated with non-operative management relying on closed reduction and casting. Recently, however, there has been a trend towards increased surgical management of these fractures in an effort to improve clinical outcomes.
Long arm cast immobilization remains a viable treatment option for many of these fractures that fall within acceptable alignment parameters, and children are generally at low risk for developing significant elbow stiffness following cast immobilization. For fracture patterns, which are unable to be closed reduced to an acceptable position, surgical management is recommended.
Surgical treatment options include both rigid plate fixation and elastic intramedullary nails. Elastic intramedullary nails were originally developed in the early s by surgeons in Nancy, France.
However, many of the studies in the literature on this topic are retrospective in design and are limited in the number of patients they contain. Epidemiology Pediatric fractures present significant challenges to the orthopedic community. The most common location of injury is predictably a playground area. Conservative management The gold standard for pediatric forearm fractures remains closed reduction and casting.
It is generally accepted that the closer the fracture is to the distal physis, the greater the potential for remodeling. Consequently more deformity can be accepted in the distal one third of the diaphysis versus the middle and proximal thirds. However, a review of the literature is inconclusive in defining precise guidelines for acceptable deformity Table 1. Table of recommended acceptable alignment parameters for both-bone pediatric forearm fracture.
Radius and Ulnar Shaft Fractures
Imaging differential diagnosis Epidemiology Forearm fractures are seen in all age-groups although as with most simple trauma, there is a bimodal age and sex distribution with high-trauma injuries in the younger age-group and simple falls in the older age-group. Clinical presentation The majority of patients present with a history of trauma to the forearm and pain. They are reluctant to move their wrist or elbow and depending on the severity of the injury there may be a deformity. An x-ray of the forearm will determine the type of injury that has occurred. In most cases, there will either be a paired radial and ulnar fracture or an isolated radial fracture and dislocation of the distal or proximal radioulnar joint. Radiographic features Forearm fractures are readily diagnosed on plain radiographs, and further imaging is rarely required. Plain radiograph AP and lateral X-rays of the forearm are performed.
Both Bone Forearm Fracture - Pediatric
LAPORAN PENDAHULUAN FRAKTUR ANTEBRACHII