Greenstick fractures of the middle third of the forearm. A prospective multi-centre study.

Details

Serval ID
serval:BIB_6A46EACD1248
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Greenstick fractures of the middle third of the forearm. A prospective multi-centre study.
Journal
European Journal of Pediatric Surgery
Author(s)
Schmuck T., Altermatt S., Büchler P., Klima-Lange D., Krieg A., Lutz N., Muermann J., Slongo T., Sossai R., Hasler C.
ISSN
1439-359X[electronic], 0939-7248[linking]
Publication state
Published
Issued date
2010
Volume
20
Number
5
Pages
316-320
Language
english
Abstract
BACKGROUND: Greenstick fractures suffered during growth have a high risk for refracture and posttraumatic deformity, particularly at the forearm diaphysis. The use of a preemptive completion of the fracture by manipulation of the concave cortex is controversial and data supporting this approach are few. AIM: Aim of this study was to determine the factors which predispose to refracture and deformities, and to define therapeutic strategies.
METHODS: We prospectively gathered clinical and radiographic data over a period of one year on greenstick fractures of the middle third of the forearm in children as part of a multi-centre study. Endpoint was a follow-up visit at one year. Radiographic deformity, state of consolidation at resumption of physical activities and refracture rate were analysed statistically (ANOVA, Student's t-test and Pearson's chi-square test) with regard to patient age, gender, fracture type, therapy and time in plaster.
RESULTS: We collected the data of 103 patients (63 boys, 40 girls), average age 6.6 years (1.3-14.5 years), the vast majority of whom had a combined greenstick fracture of the radius and ulna. 6.7% of the patients sustained a refracture within 49 days (29-76) after plaster removal. They were significantly older (p=0.017) with a significantly higher incidence of manual completion of the fracture with radiographic signs of partial consolidation (p=0.025). Residual deformities were significantly smaller after completion of the fracture compared to reduction without completion (p=0.019) or plaster fixation alone (p<0.005).
CONCLUSIONS: Completion of a greenstick fracture does not prevent refracture. Nevertheless, it diminishes the extent of secondary deformities in cases where the primary angulation exceeds the remodelling capacity. Prevention of refracture should include a routine radiographic follow-up 4-6 weeks after injury with continuation of plaster fixation in cases of partial consolidation.
Keywords
greenstick fractures, middle third, forearm, shaft, refracture, children, refractures, bones
Pubmed
Web of science
Create date
24/11/2010 11:30
Last modification date
20/08/2019 14:25
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