Forearm longitudinal discrepancy after forearm fractures' fixation in pediatric: A case series study

Document Type : Original Article

Authors

Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

10.4103/atr.atr_58_22

Abstract

Background and Objectives: Forearm fractures in childhood are one of the most common traumatic injuries to the upper extremities. The aim of this study was to investigate the development of growth disturbance after surgical treatment of pediatric forearm fractures and the related factors. Methods: This retrospective descriptive study was conducted on, 38 children with unstable forearm fractures undergoing surgical treatment. Growth disorder, either overgrowth or undergrowth, was investigated using imaging findings. Functional dysfunction, loss of motion, and pain severity were also evaluated in children with developmental disorders. Results: In 13 children (34.2%), forearm longitudinal growth disorder had occurred as overgrowth and no undergrowth was observed in any of the pediatric follow-up periods. The minimum increase in longitudinal growth was 4 mm and the maximum was 10 mm. The mean longitudinal growth was 5.8 ± 1.6 mm. All cases of increased longitudinal overgrowth occurred in the radius. In one case, the longitudinal overgrowth was followed by fixation with Titanium Elastic Nail, and in 12 cases, it was followed by plate fixation. In cases with the increase in longitudinal growth, 12 cases (92.4%) of fractures were in the distal third and 1 case (7.6%) was in the midshaft third. Based on age, there was a significant negative correlation between longitudinal growth and age, so that with decreasing the age of children, the amount of forearm growth increases (P = 0.002, R = −0.8) Conclusions: The most common finding of surgical treatment of pediatric forearm fractures is longitudinal overgrowth. Young age, fractures in the distal third, and the use of plate for fixation appear to be associated with forearm longitudinal overgrowth.

Highlights

Ali Tabrizi [Pubmed] [Google Scholar]

 

Keywords


1.
Guitton TG, Van Dijk NC, Raaymakers EL, Ring D. Isolated diaphyseal fractures of the radius in skeletally immature patients. Hand (N Y) 2010;5:251-5.  Back to cited text no. 1
    
2.
Kelly BA, Shore BJ, Bae DS, Hedequist DJ, Glotzbecker MP. Pediatric forearm fractures with in situ intramedullary implants. J Child Orthop 2016;10:321-7.  Back to cited text no. 2
    
3.
Stilli S, Magnani M, Lampasi M, Antonioli D, Bettuzzi C, Donzelli O. Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children. Chir Organi Mov 2008;91:13-9.  Back to cited text no. 3
    
4.
Dai CQ, Yang J, Guo XS, Sun LJ. Risk factors for limb overgrowth after the application of titanium elastic nailing in the treatment of pediatric femoral fracture. J Orthop Sci 2015;20:844-8.  Back to cited text no. 4
    
5.
Teoh KH, Chee YH, Shortt N, Wilkinson G, Porter DE. An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture. J Child Orthop 2009;3:367-73.  Back to cited text no. 5
    
6.
Fernandez FF, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: Plate fixation versus intramedullary nailing. Injury 2005;36:1210-6.  Back to cited text no. 6
    
7.
Kuo FC, Kuo SJ, Ko JY. Overgrowth of the femoral neck after hip fractures in children. J Orthop Surg Res 2016;11:50.  Back to cited text no. 7
    
8.
de Pablos J, Franzreb M, Barrios C. Longitudinal growth pattern of the radius after forearm fractures conservatively treated in children. J Pediatr Orthop 1994;14:492-5.  Back to cited text no. 8
    
9.
Carsi B, Abril JC, Epeldegui T. Longitudinal growth after nonphyseal forearm fractures. J Pediatr Orthop 2003;23:203-7.  Back to cited text no. 9
    
10.
Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW. Accuracy and reliability of the mayo elbow performance score. J Hand Surg Am 2014;39:1146-50.  Back to cited text no. 10
    
11.
Friedrichsdorf SJ, Kang TI. The management of pain in children with life-limiting illnesses. Pediatr Clin North Am 2007;54:645-72, x.  Back to cited text no. 11
    
12.
Cravino M, Oni JK, Sala DA, Chu A. A radiographic study of pediatric ulnar anatomy. J Pediatr Orthop 2014;34:537-41.  Back to cited text no. 12
    
13.
Williams AA, Szabo RM. Case report: Radial overgrowth and deformity after metaphyseal fracture fixation in a child. Clin Orthop Relat Res 2005;435:258-62.  Back to cited text no. 13
    
14.
Cremer P, Angelliaume A, Lalioui A, Cellarier G, Harper L, Lefevre Y. Functional and radiological outcome after forearm plating in children and adolescent fracture. Acta Orthop Belg 2021;87:143-9.  Back to cited text no. 14
    
15.
Nielsen AB, Simonsen O. Displaced forearm fractures in children treated with AO plates. Injury 1984;15:393-6.  Back to cited text no. 15
    
16.
Rouhani A, Tabrizi A, Afshar A, Elmi A. Longitudinal overgrowth of the forearm after fracture fixation with flexible intramedullary nail: A case report and review of the literature. Trauma Mon 2018;23:e63088.  Back to cited text no. 16