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Long-term results following pediatric distal forearm fractures

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Abstract

Introduction

The purpose of this retrospective study was to investigate the frequency and extent of clinical and radiological late sequelae and to identify predicting factors.

Materials and methods

A total of 220 patients of growing age with 232 closed, conservatively treated fractures were re-examined clinically and radiologically at a median follow-up time of 10 years (range 5–16 years). Clinical and radiological findings were summarised as an overall result.

Results

Of the total of patients, 19% reported pain in the injured wrist, and wrist mobility was limited in 5% of patients. Forearm rotation was decreased in 16%, primarily in epiphyseal separation of the ulna (p=0.0033). Radial inclination was different in 6% of patients, palmar tilt in 2%, and ulnar variance in 37%, compared with the contralateral side. Ulnocarpal impaction syndrome was present in 75% of the patients with positive ulnar variance. Overall outcome was excellent in 72%, good in 19%, moderate in 6%, and poor in 3% of patients. The younger the children were at the time of injury, the more favourable the results were (p=0.009). Children who were older than 10 years when they suffered a severe fracture dislocation had the poorest results (p=0.008). Further factors having a negative influence on outcome were repeated reduction maneuvers and an additional fracture of the ulna.

Conclusion

Our follow-up examinations showed that the majority of patients achieved good results, especially in children under 10 years old. Large dislocations at the time of fracture healing do not influence long-term results in this age group and thus can be tolerated. Patients over 10 years old, whose fractures healed with an angular deformity of more than 20° and/or fragment dislocation over half the breadth of the shaft showed the poorest results. Thus, such dislocations should not be tolerated, and reduction should be attempted in this age group by only one reduction maneuver.

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Fig. 1a-f
Fig. 2
Fig. 3a–d
Fig. 4
Fig. 5a–i

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Acknowledgement

We express our thanks to Georg Thieme Verlag Stuttgart, New York, for providing and granting permission to print Figs. 1 and 5, which were originally published in Handchirurgie Mikrochirurgie Plastische Chirurgie 2000; 32 (4): 242–249.

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Authors and Affiliations

  1. Department of Trauma Surgery and Sports Medicine, University of Innsbruck, Anichstrasse 35, , 6020, Innsbruck, Austria

    Robert Zimmermann, Martin Gschwentner, Franz Kralinger, Rohit Arora, Markus Gabl & Sigurd Pechlaner

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  1. Robert Zimmermann
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  2. Martin Gschwentner
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  3. Franz Kralinger
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Correspondence to Robert Zimmermann.

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Zimmermann, R., Gschwentner, M., Kralinger, F. et al. Long-term results following pediatric distal forearm fractures. Arch Orthop Trauma Surg 124, 179–186 (2004). https://doi.org/10.1007/s00402-003-0619-4

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