Session V - Pediatrics

Fri., 10/6/06 Pediatrics & Spine, Paper #27, 11:18 am

Stiffness following Displaced Pediatric Both-Bone Forearm Fractures: A Meta-Analysis

R. Michael Greiwe, MD1 (n); Charles T. Mehlman, DO2 (n);
Edward Moon3 (*); Eric Wall, MD2 (*); Alvin Crawford, MD2 (*);
1University of Cincinnati Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA;
2University of Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA;
3University of Cincinnati College of Medicine, Cincinnatti, Ohio, USA

Introduction: Displaced both-bone forearm fractures are common pediatric injuries. Management of these fractures can be difficult because of their inherent instability. Two philosophies exist regarding the treatment of these fractures: casting and intramedullary (IM) fixation. Unfortunately, the two techniques have not been researched in prospective, randomized controlled trials. The purpose of this study was to compare range of motion (ROM) loss and complications in IM fixation and closed reduction and casting using a meta-analysis.

Materials and Methods: A literature search was conducted to find articles in the English literature from 1970 to the present on displaced, pediatric both-bone forearm fractures. Nine IM treatment articles and six closed treatment papers were identified. Each paper had precise ROM and complication data. Papers were reviewed and ROM and complications were tabulated for each group. Pronation and supination loss was divided into mild (15°-35°), moderate (36°-59°) and severe (60°). Complications were separated into minor and major categories. Data analysis was performed by the chi-squared test.

Results: Mild and moderate ROM loss was more prevalent in the closed treatment group (P <0.05, see table below). In addition, IM fixation had more minor complications (P <0.05), but major complications were similar.

   15°-35° (Mild)  36°-59° (Moderate)  60° (Severe)
 IM Fixation:  14/278  0/278  1/278
 Casting:  40/219  9/219  5/219
 P-value:  <0.05  <0.05  0.051

Conclusions: Our meta-analysis identified that pronation and supination losses are more prevalent using a closed reduction and casting technique. IM fixation is associated with more minor complications, but major complications were similar. IM fixation is a viable option in the treatment of displaced, both-bone forearm fractures in children.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.