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Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

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2199-5737
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A 5-year Overview of Forearm Fracture Etiology and Treatment Options in 7-15 Years Old Children

Janis Upenieks
  • Corresponding author
  • Department of Pediatric Surgery, University Children’s Hospital (Riga, Latvia)
  • Department of Pediatric Surgery, Riga Stradins University (Latvia)
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Sintija Sloka / Aigars Petersons
  • Department of Pediatric Surgery, University Children’s Hospital (Riga, Latvia)
  • Department of Pediatric Surgery, Riga Stradins University (Latvia)
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Anita Villerusa
Published Online: 2013-05-11 | DOI: https://doi.org/10.2478/v10163-012-0008-6

Summary

Introduction. Forearm fractures make up a significant part of overall fracture rate in pediatric population, especially in 7-15 years old children. Different methods of treatment have been used, depending on the age of children and type and localization of fracture. Most controversies can be seen among conservative and surgical methods of treatment.

Aim of the Study. The aim of our study is to identify common localizations and types of forearm bone fractures in pediatric population, as well as analyze patient data and treatment process depending on selected method of treatment for out-patients and in-patients.

Materials and Methods. Retrospective analysis of out-patient and in-patient records, treated in University Children’s hospital from 2007 to 2011 was made, including first time patients with fractures of one or both forearm bones, according to ICD-10 codes S52.0- S52.9. Demographical data, trauma mechanisms, localization and type of fracture, as well as applied treatment and stay length at hospital were analyzed. 1742 out-patients and 1029 in-patients, 7-15 years old at the moment of trauma, were included in this research.

Results. 2771 forearm fractures were registered, 62.9% patients were treated on out-patient basis, 37.1 % patients required treatment in hospital. Forearm bone fractures were gender specific - 2235 boys and 536 girls had to be treated (Male:Female ratio was 4.2 : 1). The peak incidence was seen in 13 years old boys and girls. Boys suffered from forearm fractures more often in any age group. Most common mechanisms of injuries causing forearm fractures in children were related with sports trainings - 22.1%, skiing - 15.0% and traffic injuries - 10.0%. Most common activities at the moment of trauma differ by season - during winter months they include skiing, skating and sledging while in summer falls from height, bicycles and swings are dominant. Several trauma mechanisms, like sport trainings, are not season-dependent. Some injury mechanisms differ significantly by gender. Boys were more often as girls injured during sports trainings and skiing, while girls experience forearm fractures due to bicycling and skating. Occurrence of forearm fractures in children has seasonal differences with two peaks: from June to August and from December to February. Distal forearm fractures are the most often seen localization of overall forearm fractures (42 % in boys and 36 % in girls). In out-patients group conservative treatment was performed - plaster immobilization in 1339 cases and closed reduction, followed by plaster immobilization in 403 cases. In-patients were treated both - conservatively with immobilization in 21 cases and closed reduction in 188 cases, and surgically with K-wire osteosynthesis in 137 cases or elastic stable intramedullary nailing (ESIN) in 683 cases. The type and localization of each fracture, along with the age of patient, are the key factors for choosing the right treatment method. K-wire osteosynthesis was performed in all age groups for unstable fractures in distal or proximal third of forearm. ESIN was a method of choice for unstable or comminuted midshaft fractures of one or both bones, metadiaphyseal fractures and some specific conditions (radial neck fractures, Monteggia fractures-dislocations), especially in older patients. Stay length at hospital was ranging from 1 to 2 hospital days in case of immobilization (mean = 1,05 days), from 1 to 4 days in closed reduction group (mean = 1,32 days), but 1 to 12 days in hospital spent children after K-wire osteosynthesis (mean = 1,99 days) or ESIN (mean = 2,38 days).

Conclusions.

1. Forearm fractures in children have a significant gender diversity (M : F ratio is 4,2 : 1).

2. Peak incidence group is 13 years old adolescents of both genders.

3. Seasonality and season-specific injury patterns are typical for pediatric forearm fractures.

4. The most common anatomic localization is the distal segment of forearm bones.

5. Younger children (7-9 years) are mainly treated by conservative methods, while methods of choice for treatment of forearm fractures in adolescents (13-15 years) are operative.

6. Surgical treatment of fractures do not significantly increase stay length at hospital.

Keywords : Forearm fractures; children; treatment options

  • 1. Bae DS. Pediatric Distal Radius and Forearm Fractures // The Journal of Hand Surgery, 2008; 33-A (10): 1911-1923 Web of ScienceGoogle Scholar

  • 2. Cannata G, De Maio F, Mancini F, Ippolito E et al. Physeal fractures of the distal radius and ulna: long-term prognosis // The Journal of Orthopedic Trauma, 2003; 17(3): 172-179 Google Scholar

  • 3. Charles TM, Enric JW. Injuries to the shafts of the radius and ulna // Rockwood & Wilkins’ Fractures in Children // Ed. by Beaty J. H., Kasser J. R. - 6th ed. - Lippincott Williams & Wilkins, 2006; 400-438 Google Scholar

  • 4. Chung KC, Spilson SV. The Frequency and epidemiology of hand and forearm fractures in the United States // The Journal of Hand Surgery [Am], 2001; 26: 908-915. CrossrefGoogle Scholar

  • 5. Cooper C, Dennison EM, Leufkens HGM et al. Epidemiology of Childhood Fractures in Britain: A Study Using the General Practice Research Database // Journal of Bone and Mineral Research, 2004; 19 (12): 148-150 Google Scholar

  • 6. Dhar D, Varghese TP. Audit of Inpatient Management and Outcome of Limb Fractures in Children // Oman Medical Journal, 2011; 26 (2): 132-134 Google Scholar

  • 7. Freih OAH. Hand dominance and gender in forearm fractures in children // Strategies in trauma and limb reconstruction, 2008; 3(3): 101-103 Google Scholar

  • 8. Hedström EM, Svensson O, Bergström U, Michno P. Epidemiology of fractures in children and adolescents // Acta Orthopaedica, 2010; 81 (1): 148-153 CrossrefPubMedGoogle Scholar

  • 9. Laer L. Specific injuries - upper extremities // Pediatric fractures and dislocations/ Ed. by Laer L. - 4th ed. - Georg Thieme Verlag, 2004; 179-255 Google Scholar

  • 10. Ogden JA. Radius and ulna // Skeletal injury in the child / Ed. by Ogden J. A. - 3rd ed. - New York: Springer-Verlag, Inc., 2000; 567-649 Google Scholar

  • 11. Petersen HA. Epiphyseal Growth Plate Fractures. - Berlin, Heidelberg: Springer-Verlag, 2007; 227-272, 525-547, 695-748 Google Scholar

  • 12. Va lerio G, Galle F, Mancusi C, et al. Pattern of fractures across pediatric age groups: analysis of individual and lifestyle factors // BMC Public Health, 2010; 10: 4-9Web of SciencePubMedGoogle Scholar

About the article

Published Online: 2013-05-11

Published in Print: 2012-12-01


Citation Information: Acta Chirurgica Latviensis, Volume 12, Issue 1, Pages 36–40, ISSN (Print) 1407-981X, DOI: https://doi.org/10.2478/v10163-012-0008-6.

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