Work

Pediatric Both Bone Forearm Fractures: Re-evaluating Unacceptable Alignment and Remodeling Potential in Children up to 11 Years Old

Year: 2025

Type: article

Abstract: Background: Nonoperative management utilizing closed reduction and immobilization is considered standard of care for pediatric both bone forearm fractures (BBFFs) when alignment meets Noonan and Price criteria (JAAOS 1998). A previous series of patients at our institution revealed a subpopulation who healed outside of these parameters but were asymptomatic. Methods: A prospective study of patients with healed fractures at standard 6 to 12-week follow-up with residual sagittal or coronal angulation ≥15° was performed with minimum 2-year follow-up. Patients underwent forearm radiographs, physical examination, and completed PedsQL (Pediatric Quality of Life Inventory). Radiographs at 2 years were compared to those taken at the last standard follow-up to evaluate remodeling. Physical examination was compared between the normal and injured sides and to published norms. PedsQL scores below 1 standard deviation (SD) from the published mean were considered abnormal. Results: > .05). Six (27%) patients scored more than 1 SD below the mean on PedsQL but had no significant differences in other variables or range of motion compared to patients within 1 SD. Conclusions: Pediatric BBFFs demonstrated significant remodeling potential without long-term consequences to function or patient-reported outcomes at 2-year follow-up. Although this study has a small population of primarily young patients, it does include 6 patients 9-11 years of age. This may support re-evaluating current recommendations for acceptable alignment of pediatric BBFF in this group. Key Concepts: (1)Both bone forearm fractures with ≥15° malunion at 6-8 weeks post injury have the capacity to remodel in patients up to 11 years of age.(2)Significant range-of-motion deficits did not develop in these observed both bone forearm fracture malunions. Level of Evidence: II.

Source: Journal of the Pediatric Orthopaedic Society of North America

DOI: 10.1016/j.jposna.2025.100305