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Paediatric forearm fractures: functional outcome of conservative treatment

Tarmuzi NA, Abdullah S, Osman Z, Das S

Bratisl Lek Listy, 2009;110(9):563-8.
PMID: 19827340

Forearm fractures are common in the paediatric age group. Closed reduction and casting are the primary means of treatment in over 90% of these fractures. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational deformity and fragment displacement.

Matched MeSH terms: Ulna Fractures/radiography; Ulna Fractures/therapy*
Fulltext Bilateral Olecranon Fracture in Adult. A Case Report

Zamzuri, Z., Nazri, M.Y., Amindudin, C.A., Azril, A., Shukrimi, A., Hafiz, A., et al.

International Medical Journal Malaysia, 2006;5(1):1-3.
MyJurnal

We report a case of a 14-year-old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open reduction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactory.

Matched MeSH terms: Ulna Fractures
Evaluation of Osteogenic Potentials of Avian Demineralized Bone Matrix in the Healing of Osseous Defects in Pigeons

Sanaei R, Abu J, Nazari M, Zuki MA, Allaudin ZN

Vet Surg, 2015 Jul;44(5):603-12.
PMID: 25656987 DOI: 10.1111/vsu.12292

To evaluate avian allogeneic demineralized bone matrix (DBM) in the healing of long bone defects as a function of geometry and time in a pigeon model.

Matched MeSH terms: Ulna Fractures/surgery; Ulna Fractures/veterinary*
Fulltext The effect of strontium ranelate on the healing of a fractured ulna with bone gap in rabbit

Ibrahim MR, Singh S, Merican AM, Raghavendran HR, Murali MR, Naveen SV, et al.

BMC Vet Res, 2016 Jun 16;12(1):112.
PMID: 27307015 DOI: 10.1186/s12917-016-0724-6

Fracture healing in bone gap is one of the major challenges encountered in Orthopedic Surgery. At present, the treatment includes bone graft, employing either internal or external fixation which has a significant impact on the patient, family and even society. New drugs are emerging in the markets such as anabolic bone-forming agents including teriparatide and strontium ranelate to stimulate bone growth. Based on the mechanism of their actions, we embarked on a study on the healing of a fractured ulna with bone gap in a rabbit model. We segregated ten rabbits into two groups: five rabbits in the test group and five rabbits in the control group. We created a 5 mm bone gap in the ulna bone, removing the periosteum as well. Rabbits in the test group received 450 mg/kg of strontium ranelate via oral administration, daily, for six weeks. The x-rays, CT scans and blood tests were performed every two weeks. At the end of six weeks, the rabbits were sacrificed, and the radius and ulna bones harvested for histopathological examination.

Matched MeSH terms: Ulna Fractures/drug therapy*; Ulna Fractures/pathology
Fulltext Early remodeling in children's forearm fractures

Qairul IH, Kareem BA, Tan AB, Harwant S

Med J Malaysia, 2001 Dec;56 Suppl D:34-7.
PMID: 14569764

The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all children's fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month: the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10-20 degree angulation in midshaft fractures, and a 20-30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.

Matched MeSH terms: Ulna Fractures/physiopathology*; Ulna Fractures/therapy
Fulltext Locking compression plate: a treatment option for diaphyseal nonunion of radius or ulna

Ling HT, Kwan MK, Chua YP, Deepak AS, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:8-12.
PMID: 17600986

Treatment of radius or ulna nonunion requires both osteogenic environment and mechanical stability. We would like to report three radial and six ulnar diaphyseal nonunions treated with 3.5 mm locking compression plate (LCP) fixation. To assess the effectiveness of 3.5 mm LCP in treating diaphyseal nonunion of the forearm bones, we prospectively reviewed nine patients with the mean age of 33 years with diaphyseal nonunion of the radius or ulna. All patients were treated with 3.5 mm LCP. Bone grafting was only performed for atrophic nonunion. Surgical and functional outcome were evaluated. There were three atrophic nonunion of the radius, four atrophic nonunion of the ulna and two hypertrophic nonunion of the ulna. All nonunion united successfully with satisfactory functional outcome. 3.5 mm LCP is effective in the treatment of nonunion of ulna or radius.

Matched MeSH terms: Ulna Fractures/radiography; Ulna Fractures/surgery*
Fulltext Comparison of fracture patterns between rural and urban populations in a developing country

Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG

Singapore Med J, 2010 Sep;51(9):702-8.
PMID: 20938610

The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.

Matched MeSH terms: Ulna Fractures/diagnosis; Ulna Fractures/pathology
A Case of Non-Union of Ulna Fracture Managed with Tibial Strut Cortico-Cancellous Bone Grafting in a Paediatric Patient

Looi CSK, S A R, Gill RS

J Hand Surg Asian Pac Vol, 2017 Sep;22(3):396-402.
PMID: 28774257 DOI: 10.1142/S0218810417720327

Forearm fractures in children complicated with non-union are uncommon. Various methods have previously been reported to manage this condition. Well documented techniques would include iliac crest grafting, cancellous insert grafting, ulnar segment grafting, cortical tibial grafting, vascularized fibular grafting and bone transport by ring fixation. The authors present a case of a child with an atrophic non-union of the ulna who was successfully treated with a cortico-cancellous tibial strut bone graft.

Matched MeSH terms: Ulna Fractures/surgery*
Fulltext The Effect of Intra-carpal Kirschner Wire Augmentation in Screw Fixation of Scaphoid - A Retrospective Cohort Study

Leow M, Chung SR, Tay SC

Malays Orthop J, 2020 Nov;14(3):104-109.
PMID: 33403069 DOI: 10.5704/MOJ.2011.016

Introduction: Scaphoid fractures are most often treated with a single headless compression screw. However, intercarpal Kirschner wire (K-wire) might be added to improve stability and fracture outcomes. This study will determine if there is a difference in treatment outcome (union rate and time to union) between scaphoid fracture fixations using a single headless compression screw with and without augmentation using a intracarpal intramedullary K-wire.
Material and Methods: We conducted a retrospective review of patients who underwent surgery for isolated scaphoid fractures over a 15 years period from December 2000 to December 2015. Only patients who underwent open surgery with bone grafting were included. They were divided into a group treated with a single screw fixation, and another group treated with screw and K-wire fixations.
Results: Forty-four (58.7%) patients had single screw fixation and 31 (41.3%) had screw augmented with K-wire fixation. The overall union rate was 88.0%, with an overall mean time to union of 5.3 months. There was no difference in union rate (p=0.84) and time to union (p=0.66) between the single screw group and combined screw and K-wire group. Univariate analysis found that older age (t=-2.11, p=0.04) had a significant effect on union rate. Regression model showed that age had a significant effect on months to union.
Conclusion: In open fixation of scaphoid fractures with compression screw and bone grafting, union rate and time to union is comparable whether or not screw fixation was augmented with an intracarpal K-wire. There was no increased risk of complications associated with augmented screw. Age of patient affected time to union and union rate.

Matched MeSH terms: Ulna Fractures
Fulltext Two-Year Outcome of Synthetic Annular Ligament Reconstruction in the Elbow: A Case Report

Kesu Belani L, Abdullah S, Harun MH, Narin Singh PSG, Sapuan J

Cureus, 2020 Nov 19;12(11):e11564.
PMID: 33364091 DOI: 10.7759/cureus.11564

Monteggia fracture is commonly treated with open anatomical reduction and fixation of the ulna fracture. The radial head will be automatically reduced once anatomical fixation of the ulna is achieved. However, it is occasionally associated with an irreducible radial head dislocation requiring an open reduction and reconstruction of the torn annular ligament. We describe a case of traumatic Monteggia fracture which underwent initial plating, however post-operative radiograph denoted an irreducible radial head secondary to a ruptured annular ligament. We reconstructed the annular ligament with a synthetic graft sling around the radial neck with an anchor suture. The radial head was stable in all directions after annular ligament reconstruction. A two-year follow-up shows full range of motion of the elbow joint with osteolysis of the radial head, no other operative morbidity was observed.

Matched MeSH terms: Ulna Fractures
Fulltext Humeral Supracondylar Fractures in Children: A Novel Technique of Lateral External Fixation and Kirschner Wiring

Kow RY, Zamri AR, Ruben JK, Jamaluddin S, Mohd-Nazir MT

Malays Orthop J, 2016 Jul;10(2):41-46.
PMID: 28435560 MyJurnal DOI: 10.5704/MOJ.1607.008

Introduction: Supracondylar fracture of the humerus is the most common fracture around the elbow in children. Pinning with Kirschner wires (K-wires) after open or closed reduction is generally accepted as the primary treatment modality. However, it comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity. We present our two-year experience with a new technique of lateral external fixation and K-wiring of the humeral supracondylar fracture. Materials and Methods: A total of seven children with irreducible Gartland Type III supracondylar humeral fracture were treated with closed reduction and lateral external fixation and lateral Kirschner wiring. Patients with ipsilateral radial or ulnar fracture, open fracture and presence of neurovascular impairment pre-operatively were excluded. All the patients were followed up at one, three and six weeks and three and six months. The final outcomes were assessed based on Flynn's criteria. Results: All the patients achieved satisfactory outcomes in terms of cosmetic and functional aspects. All patients except one (85.5%) regained excellent and good cosmetic and functional status. One patient (14.3%) sustained pin site infection which resolved with oral antibiotic (Checketts- Otterburn grade 2). There was no neurological deficit involving the ulnar nerve and radial nerve. Conclusion: The introduction of lateral external fixation and lateral percutaneous pinning provide a promising alternative method for the treatment of humeral supracondylar fracture. This study demonstrates that it has satisfactory cosmetic and functional outcomes with no increased risk of complications compared to percutaneous pinning.

Matched MeSH terms: Ulna Fractures
Fulltext Both-Bone Forearm Fractures in Children with Minimum Four Years of Growth Remaining: Can Cast Achieve a Good Outcome at Skeletal Maturity?

Hadizie D, Munajat I

Malays Orthop J, 2017 Nov;11(3):1-9.
PMID: 29326760 MyJurnal DOI: 10.5704/MOJ.1711.009

Introduction: Both-bone forearm fractures in children can be treated non-operatively with a cast. Most previous studies have shown favourable outcome; however, information on the functional outcome after skeletal maturity is still scanty. Therefore, this study was conducted to determine the functional outcome after skeletal maturity in fractures with at least four years of growth remaining. Materials and Methods: This retrospective study was conducted from March 2012 until March 2013. Age at the time of fracture was taken as until 10 years for females and until 12 years old for males with at least four years of growth remaining. Fractures occurring in the diaphysis were included in the study. Functional outcomes were assessed at or after skeletal maturity. Results: Forty-four children fulfilled the criteria. The ages of the youngest and the oldest at the time of fracture was five and 12 years old respectively. Follow-up of the male and female patients were 7.4 years and 5.5 years respectively. There was a significant difference between post-reduction angulation and angulation at skeletal maturity of the radius and ulna (p<0.001). Out of 44 patients, 39 had excellent and five had good functional outcomes. No patient had fair or poor functional outcome. There was no association between the functional outcome and the angulation of forearm bones after skeletal maturity. Age at the time of fracture had a significant association with the functional outcome. Conclusion: Non-operative treatment of both-bone diaphyseal forearm fractures in a cast has good to excellent functional outcomes in children who still have four years of growth remaining.

Matched MeSH terms: Ulna Fractures
Pain Perception During the Phases of Manual Reduction of Distal End Radius Fracture With a Periosteal Block

Wan Ali WAA, Soh EZF, Abdullah S, Narin Singh PSG, Ahmad AA, Sapuan J

Cureus, 2021 Jan 13;13(1):e12691.
PMID: 33604222 DOI: 10.7759/cureus.12691

Introduction Closed reduction is an effective method of treatment for distal end radius fractures. We present a case series of patients with distal end radius fractures who underwent closed manipulative reduction using the periosteal block. We describe the technique in detail and examine its efficacy in pain lowering effect during closed reduction. Methods Nineteen patients with distal end radial and ulnar fractures were included and grouped based on the Frykman classification. The reduction was performed using a periosteal block of 10 ml of 2% lignocaine injection. The severity of pain was recorded by utilizing the visual analog scale (VAS) in five phases: 1) before injection, 2) after 15 minutes of analgesia in a resting position, 3) during minimal motion, 4) during full manipulation and reduction, and 5) post-procedure. The VAS scoring was classified as painless (VAS score of 0), mild pain (VAS score between 1-3), and painful (VAS score of 4 and above). Results The study included 19 patients [median age of 53 years (range: 18-88 years)]; there were 11 (58%) males and eight (42%) females. The mechanism of injury was a fall (n=12, 63%) or a motor vehicle accident (n=7, 37%). There was a statistically significant reduction of pain between phase one and all the other phases. Between the different fracture configurations, there was no significant difference in pain reduction. The most painful phase was expected to be phase four, ie, during full manipulation, in which four (21%) patients had a VAS score of 0, 12 (63%) patients had a VAS score between 1-3, and three (16%) patients had a VAS score of 4. Thus, 16 out of 19 patients (84%) had no or minimal pain during the most painful phase. There were no complications from the periosteal blocks. Conclusions The periosteal nerve block is an effective procedure providing satisfactory analgesia during the reduction of distal radial and ulnar fractures. It has no side effects and is free from complications associated with conventional sedation.

Matched MeSH terms: Ulna Fractures