Evidence-based medicine: management of pediatric forearm fractures.
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 19104, USA.
Corinna C
CC
Franklin
Jonathan
J
Robinson
Kenneth
K
Noonan
John M
JM
Flynn
D000367:Age Factors; D002648:Child; D003657:Decision Making; D019317:Evidence-Based Medicine; D005543:Forearm Injuries / Q000628:therapy; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D012107:Research Design; D016896:Treatment Outcome