Pediatric Forearm Fracture Characteristics as Prognostic Indicators of Healing

Abstract

Background

This study was conducted to investigate the characteristics, complications, radiologic features, and clinical course of patients undergoing reduction of forearm fractures to better inform patient prognosis and postoperative management.

Methodology

We conducted a retrospective chart review of 75 pediatric patients treated for forearm fractures between January 2014 and September 2021 in a 327-bed regional medical center. A preoperative radiological assessment and chart review was performed. Percent fracture displacement, location, orientation, comminution, fracture line visibility, and angle of angulation were determined by anteroposterior (AP) and lateral radiographs. Percent fracture displacement was calculated as 𝐵𝑜𝑛𝑒 𝑆ℎ𝑎𝑓𝑡 𝐷𝑖𝑠𝑝𝑙𝑎𝑐𝑒𝑚𝑒𝑛𝑡 / 𝐷𝑖𝑎𝑚𝑒𝑡𝑒𝑟 × 100% = % 𝐷𝑖𝑠𝑝𝑙𝑎𝑐𝑒𝑚𝑒𝑛𝑡. The angle of angulation and percent fracture displacement were calculated by averaging AP and lateral radiograph measurements.

Results

A total of 75 cases, averaging 11.6 ± 4.1 years, were identified as having a complete fracture of the radius and/or ulna, with 66 receiving closed reduction and nine receiving fixation via an intramedullary device or percutaneous pinning. Eight (10.7%) patients experienced complications, with four resulting in a refracture and four resulting in significant loss of reduction without refracture. Fractures in the proximal two-thirds of the radius were associated with a significant increase in complications compared to fractures in the distal one-third of the radius (33.3% vs 3.6%) (p = 0.0005). Likewise, a greater fracture displacement percentage was associated with a lower risk of refracture post-reduction as those experiencing complications had over 30% greater total displacement pre-reduction compared to patients who did not experience complications such as refracture or loss of reduction (p < 0.0001). No elevated risk of complications was found based on fracture orientation, angulation, fracture line visibility, forearm bone(s) fractured, sex, age, or arm affected.

Conclusions

Our results highlight radius fracture location and percent fracture displacement as markers with prognostic value following forearm fracture. These measurements are simply calculated via pre-reduction radiographs, providing an efficient method of informing the risk of complications following forearm fracture reduction.