Three-dimensional imaging of children with severe limitation of pronation/supination after a both-bone forearm fracture.
BACKGROUND
Although both-bone forearm fractures in children may result in severe limitation of forearm rotation, finding the cause remains a diagnostic challenge. This study tries to evaluate the role of rotational malunion, bony impingement and contractures of the interosseous membrane.


METHODS
Children (5-16 years) who suffered from a both-bone forearm fracture in diaphysis or distal metaphysis with a limitation of pronation/supination ≥40° at ≥6 months after trauma were included for analysis with conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI).


RESULTS
A total of 410 children with a both-bone forearm fracture were prospectively followed in four Dutch hospitals. At a median of 205 days, 7.3 % suffered from a limitation of pronation/supination ≥40°. 14 children were included (median limitation of 40°) and the radiographs revealed a median maximum angular malunion of 16°. CT analysis showed rotational malunion of both radius (median 19°) and ulna (median 9°). MRI analysis revealed neither bony impingement nor contractures of the interosseous membrane.


CONCLUSIONS
Three-dimensional imaging of children with a severe limitation of pronation/supination after a both-bone forearm fracture revealed rotational malunions of both radius and ulna without bony impingement or soft tissue contractures.


METHODS
Prospective multicenter study, Level 2.
Department of Orthopaedic Surgery, Erasmus Medical Center, Westzeedijk 361, Postbus 2040, 3000 CA, Rotterdam, The Netherlands, j.colaris@erasmusmc.nl.
Joost W
JW
Colaris
Stanley
S
Oei
Max
M
Reijman
Herma
H
Holscher
Jan Hein
JH
Allema
Jan A N
JA
Verhaar
D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D011403:Pronation; D011446:Prospective Studies; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D016059:Range of Motion, Articular; D013484:Supination; D014057:Tomography, X-Ray Computed; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*