A Conservative Algorithm For Treating Pediatric Both Bone Forearm Fractures: A Lower Rate Of Surgical Fixation And No Increased Risk With Delayed Surgical Treatment
Adam L Halverson, John B Erickson, Walter P Samora, *Allan C Beebe, Kevin E Klingele
Nationwide Children's Hospital, Columbus, OH
Background: Diaphyseal forearm fractures in pediatric patients are a common injury. Elastic stable intramedullary nailing (ESIN) has emerged as the surgical treatment of choice when nonoperative treatment fails. Delayed treatment with ESIN might be associated with an increased need for open passage of rods, thus increasing invasiveness of procedure and potentially delaying time to healing. We analyzed ten years of data on ESIN treatment of pediatric diaphyseal forearm fractures.Methods: Retrospective review was performed on a consecutive series of pediatric patients at a single institution who underwent intramedullary fixation of diaphyseal forearm fractures. Patient demographics, operative details, radiographs, and complications were reviewed. Findings: 2114 patients presented with pediatric diaphyseal both bone forearm fractures from January 2006 to November 2016. The majority were treated with closed reduction and casting. Fractures with unacceptable alignment at follow-up were wedged when amendable. Grade 1 open fractures were irrigated in the emergency room and admitted for 48 hours of IV antibiotics but were otherwise treated as closed. Fractures that failed closed treatment were indicated for operative stabilization. CPT code search revealed 134 operatively treated forearm fractures (6.3%). Seventy-one were treated with ESIN. The remaining patients received open reduction and internal fixation (ORIF). Six fractures were treated acutely (<48 hours). Remaining fractures were treated with ESIN at an average of 11.7 days from time of injury. Twenty-nine of 57 fractures that presented closed required open reduction to facilitate rod passage. Conclusions: Following a conservative protocol in which only fractures that failed initial attempts at closed treatment allows for far less of these injuries to require surgery.
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