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Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0b013e318259543b
EBM Supplement

Evidence-based Medicine: Management of Pediatric Forearm Fractures

Franklin, Corinna C. MD*; Robinson, Jonathan MD*; Noonan, Kenneth MD; Flynn, John M. MD*

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Abstract

Forearm fractures are common injuries in the pediatric population. Successful treatment of these fractures should result in complication-free functional pronosupination. Traditionally, these have been treated with closed reduction and casting, but the last several decades have seen a dramatic increase in the operative treatment of these fractures. However, little high-level evidence exists to guide management. The data from the limited set of studies available suggest that closed treatment does usually result in satisfactory outcomes, particularly in younger patients; operative fixation is usually successful as well but comes with a significantly increased complication rate. The ideal study to aid in evidence-based decision-making for pediatric forearm fractures would be a randomly controlled trial comparing closed reduction and casting versus intramedullary nailing versus plating; in children ranging from 8 years old to skeletally mature; with closed forearm fractures, complete or greenstick with >20 degrees of angulation; with a minimum of 5 years of follow-up (or to maturity); with the primary outcome defined as final pronation and supination; using an validated functional outcome tool; and precisely defining the complications from each treatment.

© 2012 Lippincott Williams & Wilkins, Inc.

The Pediatric Orthopaedic Society of North America (POSNA)
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