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Nonoperative versus Operative Management of Pediatric Type 1 Open Forearm Fractures: A Retrospective Review
David A. Goss Jr. DO, Andrew Mundy, MD, Julie Balch Samora MD, PhD, Allan Beebe, MD, Kevin Klingele, MD5, Walter Samora, MD. Nationwide Children's Hospital, Department of Pediatric Orthopaedic Surgery, Columbus, OH, USA.

Background: Debate exists regarding the management of type 1 open forearm fractures in the pediatric population. Although there have been studies that report good results with nonoperative management with irrigation and debridement in the emergency room , other authors contend this treatment is not sufficient. The purpose of this study is to retrospectively compare outcomes of type 1open pediatric forearm fractures treated in the ED (nonoperative) to those treated in the operating room (operative).

Methods: A retrospective chart review of 156 type 1 open fractures from 1995-2013 was performed. All patients were followed until radiographic and clinical union. The primary outcome measure was the rate of infection, and secondary measures included complication rates, surgical revision rates, length of hospital stay, and residual angulation at final follow up.

Results: There were 120 patients managed nonoperatively and 36 patients managed operatively. There was a 0% infection rate in the nonoperative group and 2.8% infection rate in the operative group, which was not statistically significant. Seven patients in the nonoperative group presented with a subsequent refracture, with only one occurring in the operative group.

Conclusions: The overall infection rate was 2.8%, with a 0% infection rate in the nonoperative group. Pediatric patients with type 1 open both bone forearm fractures can be safely managed nonoperatively, but have a low risk of refracture.

Significance: This is the largest study to date evaluating the nonoperative treatment of type 1 open forearm fractures. Our results indicate that nonoperative management of this injury is safe and effective.

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