title: Rereduction for Redisplacement of Both-Bone Forearm Shaft Fractures in Children.
abstract: BACKGROUND
  There is a high rate of redisplacement after closed reduction and cast treatment of displaced both-bone forearm shaft fractures in children. Little evidence is available on the efficacy of rereduction of these redisplaced fractures. This study evaluates the impact of rereduction on radiographic outcomes and compares the cost to surgical stabilization.
  
  
  METHODS
  This retrospective study included 31 children (mean age, 6.3 y; 18 boys) treated with rereduction for redisplacement of a displaced both-bone forearm shaft fracture between 2008 and 2013. Angulation was measured on anteroposterior and lateral radiographs of the radius and ulna at injury, after reduction, at redisplacement, after rereduction, and at fracture union. Average procedure costs for rereduction and surgical stabilization were calculated.
  
  
  RESULTS
  Initial reduction decreased apex volar angulation (initially >20 degrees) of both bones to a median of ≤2 degrees. After an average of 15 days (range, 4 to 35 d), apex volar angulation of the radius worsened to 9 degrees, and apex ulnar angulation worsened to >10 degrees for both bones. For every 5 days after initial reduction, apex ulnar angulation of the radius worsened by 4 degrees. Rereduction reduced apex ulnar and volar angulation of both bones to <5 degrees, which was maintained after cast removal. There were no complications. The average procedure cost for rereduction was $2056 compared with $4589 for surgical stabilization with or without implant removal.
  
  
  CONCLUSIONS
  Rereduction of both-bone forearm shaft fractures after redisplacement following initial closed reduction had satisfactory radiographic outcomes and is a safe, effective, and less expensive option than surgical stabilization.
  
  
  METHODS
  Level IV-therapeutic.
authors.affiliation: Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Eismann
authors.forename: Shital N
authors.initials: SN
authors.lastname: Parikh
authors.forename: Viral V
authors.initials: VV
authors.lastname: Jain
mesh_terms: D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D018483:Diaphyses; D005260:Female; D005543:Forearm Injuries / Q000628:therapy; D005592:Fracture Fixation / Q000191:economics / Q000379:methods*; D000069076:Fractures, Multiple / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000191:economics / Q000379:methods*; D011859:Radiography; D011885:Radius Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019233:Retreatment / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*