Risk of Refracture in Proximal Both Bone Forearm Fractures in Children.

BACKGROUND

Pediatric patients with proximal both bone forearm fractures appear to be at risk of refracture. We evaluated if initial treatment strategy and increasing volar angulation of the radius is associated with an increased need for rereduction or refracture.

METHODS

We performed a retrospective review of medical records of patients treated for a proximal both bone forearm fractures at a regional level one pediatric hospital. Skeletally immature patients with open physes and a proximal one-third fracture of the radius with associated ulna fracture were included. Patients with less than 4 weeks of follow-up, single-bone fracture, inadequate radiographs, or midshaft, distal, and Monteggia fractures were excluded. We did a Fisher exact test to evaluate the association of initial management strategy with refractures. A t -test compared volar angulation of the radius between refracture and no refracture groups. A logistic regression model evaluated the odds of refracture given volar angulation deformity of the radius during follow-up.

RESULTS

We identified 147 patients with a mean age of 7.9 years (SD: 3.3), approximately 55% were male. Mean follow-up was 150 days. Initial management maintained a reduction in 79.6% of cases with 20.4% of cases requiring additional treatment through cast-wedging, closed rereduction, or surgical intervention. Overall, 15 refractures (10.2%) occurred. Initial management strategies, splinting/casting in situ, closed reduction and casting, or surgical intervention, were not associated with risk of refracture. Mean volar angulation of the radius was highest among refractures at third the follow-up visit (mean: 6 weeks; 15.8° vs 6.9°; P = 0.0039) among nonsurgically treated patients. Every 1° increase in volar angulation deformity of the radius at the third follow-up visit was associated with a 1.12 times higher odds of refracture (OR, 1.12; 95% confidence interval [CI], 1.02 to 1.23; P = 0.013).

CONCLUSIONS

Increasing volar angulation of the radius at union was markedly predictive of future refracture risk. Refracture risk was not associated with initial treatment strategy. Surgeons should consider a volar angulation cutoff of less than 10° for nonsurgical management of the radius.

LEVEL OF EVIDENCE: Therapeutic IV.