[New aspects in the treatment of complete and isolated diaphyseal fracture of the forearm in childhood]

Isolated diaphyseal fractures of the radius in skeletally immature patients

Diaphyseal radius fractures without associated ulna fracture or radioulnar dislocation (isolated fracture of the radius) are recognized in adults but are rarely described in skeletally immature patients. A search of our database (1974-2002) identified 17 pediatric patients that had an isolated fracture of the radius. Among the 13 patients with at least 1 year follow-up, ten were treated with manipulative reduction and immobilization in an above elbow cast and three had initial operative treatment with plate and screw fixation. These 13 patients were evaluated for an average of 18 months (range, 12 to 45 months) after injury using the system of Price and colleagues. The incidence of isolated diaphyseal radius fractures in skeletally immature patients was 0.56 per year in our database and represented 27% of the 63 patients with a diaphyseal forearm fracture. All 13 patients, with at least 1 year follow-up, regained full elbow flexion and extension and full forearm rotation. According to the classification system of Price, all 13 patients (100%) had an excellent result. As in adults, isolated radius fractures seem to occur in children more frequently than previously appreciated. Treatment of isolated radius fractures in skeletally immature patients has a low complication rate, and excellent functional outcomes are the rule.

[Conservative treatment of fractures of the long bones during the growth phase]

In the treatment of fractures of the long bones in children and adolescents, surgical and conservative methods are not mutually exclusive alternatives; rather, each can complement the other in the overall treatment strategy. Many operative procedures, such as fixation of juxtaarticular, metaphyseal fractures, need to be supplemented by conservative procedures, such as immobilization by means of casts. We refer to methods that are performed without anaesthesia and do not involve the implantation of osteosynthetic foreign material as conservative. These are: immobilization with no further treatment, plaster wedging, and functional treatment options. The indications for purely conservative treatment strategies are basically different for articular and nonarticular fractures. Whereas in the case of articular fractures only the nondisplaced fractures are treated by conservative methods, in the case of nonarticular (shaft) fractures those involving a degree of displacement, as long as it is not too pronounced to allow the integration of spontaneous corrections, can also be treated conservatively.

Surgical treatment of unstable diaphyseal both-bone forearm fractures in children with single fixation of the radius

We retrospectively reviewed the result from 50 children (5 to 14 years; mean age 11 years) with unstable diaphyseal forearm fractures involving both the radius and ulna, for which closed reduction has been unsuccessful, and so were treated with open reduction and internal fixation of the radius only. The rationale of this treatment is to stabilize the radius as it is this bone which has the more complicated function of the two forearm bones. After anatomical reduction and fixation of the radius the ulnar fracture had a better alignment. In this series the functional and the anatomical results in all children at a mean follow up of 4 years (range 1 to 10 years) were excellent.