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Both Bone Forearm Fracture - Pediatric
Posted: May 28 2020 #(C101479)
B

Both Bone Forearm Fracture in 15M

HPI

A 15-year-old male, left-hand-dominant, presents to the office after a fall on his outstretched left hand during a basketball game 2 weeks ago. He went to an outside ER and underwent a closed reduction with casting. He has remained in the cast since. Denies any numbness or tingling of the upper extremity.

PMH

No prior medical issues or fractures

PE

Lightly worn long-arm cast in place, compartments soft with a pink well perfused hand and all nerves intact. Cast index measures 0.95

Poll
1 of 8
1. In addition to plain radiographs, would you obtain any additional imaging to guide management?
No - Current radiographs are sufficient
81%
59/72
Yes - Additional radiographic views (aXR)
6%
5/72
Yes - CT scan of the forearm (CT)
1%
1/72
Yes - MRI scan of the forearm (MRI)
1%
1/72
Yes - aXR + CT
0%
0/72
Yes - aXR + MRI
0%
0/72
Yes - CT + MRI
1%
1/72
Yes - aXR + CT + MRI
0%
0/72
Outside my area of expertise - best if I don't vote
6%
5/72
2. How would you manage this injury?
Nonoperative
25%
18/72
Operative
69%
50/72
Outside my area of expertise - best if I don't vote
5%
4/72
3. If you choose Nonoperative management, following the initial reduction at the outside ER, what would you do?
I would not choose Nonoperative management
53%
34/64
Maintain current reduction, immobilize x6-8wks
23%
15/64
Attempt re-reduction in your ER, immobilize x6-8wks
4%
3/64
Attempt re-reduction in your OR, immobilize x6-8wks
14%
9/64
Outside of my area of expertise - best is I don't vote
4%
3/64
4. If you choose Operative management, what would be your time frame to take him to surgery and where would you do it?
I would not choose Operative Management
4%
3/62
Admit to hospital - perform surgery Same day
29%
18/62
Within 5 days - Operate at a Hospital
40%
25/62
Within 10 days - Operate at a Hospital
4%
3/62
No time limit - Operate at a Hospital
3%
2/62
Within 5 days - Operate at Surgery Center
4%
3/62
Within 10 days - Operate at a Surgery Center
8%
5/62
No time limit - Operate at a Surgery Center
0%
0/62
Outside my area of expertise - best if I don't vote
4%
3/62
5. If you choose Operative management, what would be your plan going into surgery?
I would not choose Operative management
3%
2/62
Attempt Closed reduction percutaneous pinning (CRPP), convert to open only if needed
16%
10/62
Planned Open reduction percutaneous pinning (ORPP), don't attempt CRPP)
1%
1/62
Attempt Closed reduction Intramedullary flex nail (IMN) fixation, convert to open only if needed
32%
20/62
Planned Open reduction Intramedullary flex nail (IMN) fixation
1%
1/62
Planned Open reduction internal fixation (ORIF)
41%
26/62
Outside my area of expertise - best if I don't vote
3%
2/62
6. If you choose Flexible intramedullary nail fixation, which technique would you use?
I would not choose Flexible intramedullary nail fixation
32%
18/55
Antegrade Ulna ONLY (no radial instrumentation)
3%
2/55
Retrograde Ulna ONLY (no radial instrumentation)
0%
0/55
Antegrade Radius ONLY (no ulnar instrumentation)
0%
0/55
Retrograde Radius ONLY (no ulnar instrumentation)
0%
0/55
Antegrade Ulna / Antegrade Radius
1%
1/55
Antegrade Ulna / Retrograde Radius
36%
20/55
Retrograde Ulna / Antegrade Radius
20%
11/55
Retrograde Ulna / Retrograde Radius
1%
1/55
Outside of my area of expertise - best is I don't vote
3%
2/55
7. If you choose Flexible intramedullary nail fixation, how long do you immobilize the extremity postoperatively?
I would not choose Flexible intramedullary nail fixation
25%
14/54
I would not immobilize the extremity
7%
4/54
1-2 weeks
18%
10/54
3-4 weeks
24%
13/54
5-6 weeks
22%
12/54
7-8 weeks
0%
0/54
>8 weeks
0%
0/54
Outside my area of expertise - best if I don't vote
1%
1/54
8. If you choose Flexible intramedullary nail fixation, when would you schedule implant removal?
I would not choose Flexible intramedullary nail fixation
15%
8/52
I would not remove the implants - I leave them in indefinitely
0%
0/52
I would ONLY remove the implants if symptomatic
5%
3/52
<4 weeks
0%
0/52
4-6 weeks
11%
6/52
7-8 weeks
11%
6/52
9-12 weeks
13%
7/52
13-16 weeks
11%
6/52
>16 weeks
25%
13/52
Outside of my area of expertise - best is I don't vote
5%
3/52
PROCEDURE #1

Closed reduction and percutaneous intramedullary flexible nailing of radius and ulna.

icon
OUTCOMES
Post-procedure P1
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