Review Question - QID 217019

Both Bone Forearm Fracture - Pediatric Techniques Closed Reduction QID: 217019 (SBQ11OS.141.1)

QID 217019 (Type "217019" in App Search)

A 9-year-old female presents with forearm pain and deformity after she fell from the monkey bars at school. Her radiograph is depicted in Figure A. She undergoes a closed reduction her injury and is sent out for outpatient follow-up. Which of the following factors would predispose the patient to a remanipulation of her injury?

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Mechanism of injury

11/1627

Distal fracture location

40/1627

Initial fracture displacement

76%

1230/1627

Use of a below elbow cast

124/1627

Cast index <0.7

13%

211/1627

Select Answer to see Preferred Response

Remanipulation after pediatric both bone forearm fractures has been associated with increased fracture displacement.

Pediatric both bone forearm fractures are common injuries and can be treated successfully with closed reduction and casting in the majority of cases. However, remanipulation of the fracture may be necessary in certain cases due to loss of reduction has been linked to certain factors. The most common risk factor is initial fracture displacement (angulation and translation), fractures of ulna and radius and same level, and high cast index (>0.8).

McLauchlan, et al. performed a prospective, randomized controlled trial of completely displaced pediatric distal radius fractures treated with either closed reduction and casting or closed reduction and percutaneous pinning. They reported all fractures went on to union and no differences in clinical outcomes, but a significantly higher rate of remanipulation in the closed reduction and casting group. They concluded percutaneous K-wire fixation of completely displaced distal radius fractures is a reliable method to maintain reduction.

Monga, et al. retrospectively studied 164 pediatric both bone forearm fractures to assess for factors associated with remanipulation after closed reduction. They reported fractures associated with translation (p <0.0001), residual deformity after reduction (p = 0.001) were associated with remanipulation after closed reduction. They concluded that fractures with translation and residual deformity may be best treated with internal fixation.

Figure A is an AP radiograph of the left wrist depicting a completely displaced fracture of the distal radius and ulna with shortening and apex dorsal angulation.

Incorrect answers
Answer 1: Injury mechanism has not been associated with remanipulation of pediatric both bone forearm fractures.
Answer 2: Fracture location has not been associated with remanipulation after pediatric both bone forearm fractures.
Answer 4: Loss of reduction has not been associated with short arm casts compared to long arm casts.
Answer 5: A cast index >0.8 has been associated with loss of reduction.