Surgeons treating pediatric forearm fractures should pay attention to distal third fractures because an alternative fixation method may be needed, new data shows.
Does Location Matter With Pediatric Forearm Fractures?
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Secondary#distallylocatedfractures#intrameduallynailfixation#pediatricforearmfractures
In the study, “Operative Fixation of Pediatric Forearm Fractures: Does the Fracture Location Matter?” the researchers reported the clinical and radiographic outcomes from using flexible nails in pediatric forearm fractures and how procedure outcomes varied based on fracture location.
“Flexible intramedullary nails are successfully used to treat pediatric forearm fractures, especially midshaft fractures. Distal forearm fractures have been described as ‘difficult to manage’ with flexible intramedullary nails insertion,” the researchers said.
The study was published on October 16, 2021 in Advances in Orthopedics. The retrospective review included pediatric patients who had forearm fractures surgically treated with flexible nails between 2009 and 2018.
The primary outcomes were fracture radiographic union, intraoperative and postoperative complications, and the need for additional surgical procedures.
Overall there were 59 patients included in the study. The mean age was 11 years.
All fractures healed and patients regained full range of motion. In 81% of the patients, the flexible nails are successfully used. In 11 of the patients, however, it was not able to provide adequate fixation to maintain reduction. In 9 of the cases, an alternative method had to be used.
And in two of them the flexible intramedullary nail fixation was combined with another fixation method for added support.
Fractures within 3 inches of the distal articular surface were at a higher risk of intraoperative change/augmentation of the fixation (29%) compared with fractures that occurred more than 3 inches from the distal articular surface (11%).
“The majority of pediatric forearm fractures can be treated successfully with flexible nails. Surgeons involved in treating these fractures should pay attention to distal third fractures,” the researchers wrote.
“Stabilizing the distally located fractures using flexible intramedullary nails fixation can be challenging. Surgeons should be prepared to use an alternative fixation method when needed.”
The authors of the study include Ahmed Elabd of Medstar Washington Hospital Center in Washington, DC, Ramy Khalifa, Zainab Alam and Ahmed M. Thabet of TTUHSC-El Paso, Paul L. Foster SOM in El Paso, Texas and Ehab S. Saleh of the Oakland University William Beaumont School of Medicine in Rochester, Michigan. Ams Abdelgawad of Maimonidas Medical Center in Brooklyn, New York also contributed to the study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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