Complete displaced forearm distal fractures in children: A prospective study of conservative treatment

Background: Complete displaced forearm fractures in children are not very common and are usually a product of indirect trauma. They can be treated with closed reduction with plaster immobilization, closed reduction- pinning with plaster immobilization and open reduction with internal fixation. The purpose of this study is to address the importance of orthopedic treatment namely plaster immobilization for patients with this type of fractures for attaining good functional results, no further dislocation and financially acceptable.

Methods: In the study we have included 104 patients from three to nine years of age presenting between January 2009 and December 2016 with closed displaced forearm fractures and were followed prospectively. Sedation with I.V. anesthesia was performed. Fractures were manipulated and reduced with traction and rotation, followed by radioscopy then immobilized in well molded plaster casts until healed, (radio/carpal and brach/antebrach plaster immobilization). The follow up was done by Radiographs and patient controls after 3 days, 10 days, 17days; this was to reduce chances for re-displacement of the fracture. Follow up was done by radiography checks as well as after 4 weeks and at the end after 6 weeks. Patients were followed for at least 3 months.

Results: One hundred and four children with an average age of 6.27 ± 2.31years were included in the study. All fractures have been displaced of the both distal radius and ulna. The male/female ratio was 3:1. The average duration of casting was forty-three days. Three patients underwent closed re-reduction 3 days after first reduction. During the first two weeks after reduction, re-displacement occurred in none of the children. All hundred and four (104) patients achieved clinical and radiographic union with a full range of wrist motion.

Conclusion: Closed reduction with flexed elbow immobilization of displaced distal forearm fractures results in satisfactory functional outcome. Regular control after immobilization beginning from 3rd day is important for preventing the re-displacement of these fractures. Another major outcome is the cheap treatment compare to open reduction.