TY - JOUR
T1 - The risk of refracture and malunion in children treated for diaphyseal forearm fractures
T2 - a retrospective cohort study
AU - Husum, Hans Christen
AU - Rahbek, Ole
AU - Gundtoft, Per Hviid
AU - Bang, Hans Christian
AU - Kold, Søren
AU - Rölfing, Jan Duedal
AU - Abood, Ahmed
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2025
Y1 - 2025
N2 - Background and purpose — The optimal treatment modality for pediatric diaphyseal forearm fractures is debated. While nonoperative treatment and closed reduction reduces the need for surgery and surgical complications, flexible intramedullary nailing (FIN) may reduce refracture and malunion rates. We aimed to compare the relative risk (RR) of refracture and malunion between nonoperative, closed reduction (CR), and surgical treatment in children treated for diaphyseal forearm fractures. Methods — We performed a retrospective cohort study of children treated for a primary diaphyseal forearm fracture over a 9-year period at 2 university hospitals. Risk of refracture and malunion in the year following the fracture across treatment modalities was assessed by a modified Pois-son regression while adjusting for the age of the patient at the time of fracture. Results — We included 837 patients for analysis, of whom 4% were treated nonoperatively, 6% were treated with closed reduction, and 90% with FIN. Compared with FIN, the RR of refracture was higher for the nonoperative group (9.8, 95% confidence interval [CI] 5.9–16.3) and CR group (2.5, CI 1.2–5.3). Compared with the FIN group, the nonop-erative and CR groups had higher risk of malunion with RR of 15.3 (CI 11.0–21.4) and 8.5 (CI 5.8–12.5) respectively. Of those treated non-surgically, 84% remained without any surgery. In FIN patients, surgical revision due to infection was seen in 1.4% of patients. Conclusion — The risk of refracture and malunion in children treated for diaphyseal forearm fractures was sig-nificantly higher for closed reduction and nonoperative treatment compared with FIN treatment.
AB - Background and purpose — The optimal treatment modality for pediatric diaphyseal forearm fractures is debated. While nonoperative treatment and closed reduction reduces the need for surgery and surgical complications, flexible intramedullary nailing (FIN) may reduce refracture and malunion rates. We aimed to compare the relative risk (RR) of refracture and malunion between nonoperative, closed reduction (CR), and surgical treatment in children treated for diaphyseal forearm fractures. Methods — We performed a retrospective cohort study of children treated for a primary diaphyseal forearm fracture over a 9-year period at 2 university hospitals. Risk of refracture and malunion in the year following the fracture across treatment modalities was assessed by a modified Pois-son regression while adjusting for the age of the patient at the time of fracture. Results — We included 837 patients for analysis, of whom 4% were treated nonoperatively, 6% were treated with closed reduction, and 90% with FIN. Compared with FIN, the RR of refracture was higher for the nonoperative group (9.8, 95% confidence interval [CI] 5.9–16.3) and CR group (2.5, CI 1.2–5.3). Compared with the FIN group, the nonop-erative and CR groups had higher risk of malunion with RR of 15.3 (CI 11.0–21.4) and 8.5 (CI 5.8–12.5) respectively. Of those treated non-surgically, 84% remained without any surgery. In FIN patients, surgical revision due to infection was seen in 1.4% of patients. Conclusion — The risk of refracture and malunion in children treated for diaphyseal forearm fractures was sig-nificantly higher for closed reduction and nonoperative treatment compared with FIN treatment.
UR - http://www.scopus.com/inward/record.url?scp=85219533118&partnerID=8YFLogxK
U2 - 10.2340/17453674.2025.42851
DO - 10.2340/17453674.2025.42851
M3 - Journal article
C2 - 39993177
AN - SCOPUS:85219533118
SN - 1745-3674
VL - 96
SP - 189
EP - 194
JO - Acta Orthopaedica
JF - Acta Orthopaedica
ER -