The relationship between fracture configuration and open reduction in pediatric forearm fractures

Background: In pediatric forearm fractures casting and conservative treatment follow-up, a relationship has been found between re-displacement and malalignment with complete fracture, quality of the first reduction, and proximal 1/3 fracture. For similar reasons, we believe that instability in the operating room also continues and some fractures require open reduction. Objective: The aim of this study is, to predict the fractures that require mini-open intervention and to evaluate the functional results of these unstable fractures. Methods: 69 patients treated with intramedullary kischner wire [Open reduction (n:45), closedreduction (n:24)] for a pediatric forearm fracture in our clinic were reviewed retrospectively. Information regarding the age, gender, left/right side were obtained from the patients' files, and data regarding preoperative fracture displacement, angulation, localization of radius and ulna fracture, type of injury of the radius fracture, and the level of fracture. The patients were evaluated radiologically with radial inclination index and functionally with the Price criteria regarding location. Results: Open reduction and fixation were applied to 45 patients (65%). Open reduction was required when the radius fracture was non-transverse, and the fracture localization progressed proximally (p=0.039, 0.049, 0.039). No relationship was found between open reduction with age, side, gender, angled fracture, and displacement. According to the Price criteria, an excellent result in the ratio of 94% was obtained. There was no difference in mini-open fixation regarding union duration and complications. Although the radial inclination index increased in proximal and non-transverse fractures (7.8% ± 1.9), this was not reflected in functional scores. Conclusion: In pediatric forearm fractures, if the fracture is proximal or not transverse, open reduction is needed mostly and open reduction intramedullary fixation is performed successfully in these fractures.