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Evidence-based Medicine: Management of Pediatric Forearm Fractures

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

Journal of Pediatric Orthopaedics: September 2012 - Volume 32 - Issue - p S131–S134
doi: 10.1097/BPO.0b013e318259543b
EBM Supplement

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.

*Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA

American Family Children’s Hospital, Madison, WI

Performed at the Children’s Hospital of Philadelphia, Philadelphia, PA.

The authors declare no conflict of interest.

Reprint: John M. Flynn, MD, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd., Philadelphia, PA 19104. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.