title: Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study.
abstract: BACKGROUND
  Both-bone forearm fractures in children frequently result in a limitation of pronation/supination, which hinders daily activities. The purpose of this prospective multicentre study was to investigate which clinical factors are related to the limitation of pronation/supination in children with a both-bone forearm fracture.
  
  
  METHODS
  In four Dutch hospitals, consecutive children (<16 years) who sustained a both-bone forearm fracture were included. Children were followed up for 6-9 months and data from questionnaires, physical examination and X-rays were collected. Univariate and multivariate logistic regression analyses were used to assess the relationship between limitation of pronation/supination (≥20°) and several clinical factors.
  
  
  RESULTS
  A group of 410 children with both-bone forearm fractures were included, of which 10 children missed the final examination (follow-up rate of 97.6%). We found that a re-fracture (odds ratio (OR) 11.7, 95% confidence interval (CI) 1.2; 118.5), a fracture in the diaphysis (OR 3.3, 95% CI 1.4; 7.9) and less physiotherapy during follow-up (OR 0.90, 95% CI 0.82; 0.98) were independently associated with a limitation of pronation/supination of 20° or more.
  
  
  CONCLUSIONS
  These findings imply that a re-fracture and a diaphyseal located fracture were associated independently of each other with a limitation of pronation/supination in children with a both-bone forearm fracture. Furthermore, in children with severe limitation extensive physiotherapy is associated with better functional outcome.
authors.affiliation: Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: j.colaris@erasmusmc.nl.
authors.forename: Joost W
authors.initials: JW
authors.lastname: Colaris
authors.affiliation: Department of Surgery, HAGA Hospital, the Hague, The Netherlands. Electronic address: j.allema@hagaziekenhuis.nl.
authors.forename: Jan Hein
authors.initials: JH
authors.lastname: Allema
authors.affiliation: Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: m.reijman@erasmusmc.nl.
authors.forename: Max
authors.initials: M
authors.lastname: Reijman
authors.affiliation: Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands. Electronic address: VriesM@rdgg.nl.
authors.forename: Mark R
authors.initials: MR
authors.lastname: de Vries
authors.affiliation: Department of Surgery, Sint Franciscus Hospital, Rotterdam, The Netherlands. Electronic address: Dulasbiter@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Ulas Biter
authors.affiliation: Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands. Electronic address: bloem@rdgg.nl.
authors.forename: Rolf M
authors.initials: RM
authors.lastname: Bloem
authors.affiliation: Department of Paediatric Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: c.vandeven@erasmusmc.nl.
authors.forename: Cees P
authors.initials: CP
authors.lastname: van de Ven
authors.affiliation: Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: j.verhaar@erasmusmc.nl.
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001696:Biomechanical Phenomena; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011403:Pronation; D011446:Prospective Studies; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D016059:Range of Motion, Articular; D013484:Supination; D014057:Tomography, X-Ray Computed; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*
keywords: Children; Forearm fractures; Limitation of pronation/supination