Pediatric forearm fractures: Indications, technique, and limits of conservative management

Although several "minimal invasive" techniques for the operative management of pediatric forearm fractures have been developed recently, conservative treatment still remains the option with the lowest risk for small patients. We present the results of our clinical and radiological follow-up after an average of 52.4 months (4-112) in 102 pediatric patients. All fractures we re treated conservatively. There were 68 fractures (66.7%) of the distal th ird of the forearm, 30 fractures (29.4%) of the midshaft area, and four fra ctures (3.9%) in the proximal third of the shaft. Greenstick fractures were seen in 58 cases (56.8%), complete fractures with displacement of both cor ticalices in 26 patients (25.5%), and folding fractures in 18 cases (17.7%) . With the exception of one fracture with the necessity of remanipulation a fter redisplacement in the cast, all fractures healed uneventfully without any further intervention. Functional results were excellent with a free ran ge of motion of the wrist and elbow and without any signs of muscular atrop hy in 96 children (94.1%) at the time of follow-up. Six patients, however, showed a significant loss of forearm rotation of an average of 25 degrees ( 15 degrees-50 degrees). In four of these six patients, the fracture had bee n situated in the proximal and midshaft area. Thus, two out of four fractur es of the proximal forearm (50.0%) showed a poor functional outcome. On the basis of our data we recommend conservative management for (closed) pediat ric fractures of the distal and midshaft area. Operative treatment is indic ated in forearm fractures close to the elbow.