Understanding the deforming forces is essential to the reduction in both-bone forearm fractures (Fig. However, single bone forearm fractures of the ulna or radius should always raise suspicion for a Monteggia or Galeazzi fracture dislocation, respectively. Single bone forearm fractures are far less common and are typically the result of direct trauma. Pediatric forearm fractures typically follow indirect trauma, such as a fall on an outstretched hand coupled with a rotational component. Additional remodeling can also be attributed to elevation of the thick osteogenic periosteum after fracture. This polarization of growth shows why distal fractures demonstrate a higher remodeling potential than do fractures closer to the elbow. The distal radial and ulnar growth plates are responsible for 75% and 81% of the longitudinal growth of each bone, respectively. The interosseous membrane is higher strain proximally in neutral and pronation, and is higher strain distally when in supination. The radial bow, an apex lateral bend in the radius, increases the range of pronation. Radius and ulna are attached by the proximal annular ligament, by the interosseous membrane along the diaphysis, and distally by the ligaments of the distal radioulnar joint and triangular fibrocartilage complex. Anatomically, the ulna is relatively straight and static, it plays a more important role in maintaining forearm stability, especially when subjected to buckling and torsional stress. Understanding pediatric forearm anatomy offers important guidelines for treatment in the nonoperative and operative settings. Both forearm bones were fractured in 50.1% of cases of forearm injuries and there were significantly more males than females (63.6% vs. found forearm fractures to be significantly more frequent in school age children (65%) and adolescents (63%) compared to infants (42%) and preschool children (50%). Forearm fractures account for 17.8% of all fractures in pediatric age. using the 2010 NEISS report, estimated in children aged 0 to 19 years, 5,333,733 emergency room (ER) visits, of which 788,925 (14.7%) were fracture related. Furthermore, more than 20% of all patients had moderate or severe back pain at long-term follow-up.Forearm fractures are the most common type of fractures in the pediatric population, but, to date, no comprehensive overviews of their epidemiology are available. For burst fractures, no significant differences were found.īrace treatment with supplementary physical therapy is the treatment of choice for patients with compression fractures of the thoracic and lumbar spine. None of the treatments had any significant effect on the residual deformity measurements. Brace therapy scored significantly better on the Visual Analogue Scores for residual pain and on the Oswestry Disability Index. For compression fractures, physical therapy and brace were considered the most tolerable. There were 133 patients: 108 in the compression group and 25 in the burst group. Patients in the burst group received a brace or a Plaster of Paris cast, both for 12 weeks.įollow-up examinations included radiographs, Visual Analogue Scores for toleration of treatment and persistent pain, and an Oswestry Disability Index at long-term follow-up. Patients in the compression group were randomized to physical therapy and postural instructions, a brace for 6 weeks, or a Plaster of Paris cast for 6 or 12 weeks. Patients with a traumatic thoracic or lumbar spine fracture, without neurologic damage, with less than 50% loss of height of the anterior column and less than 30% reduction of the spinal canal were included. Two general hospitals in the Netherlands. Prospective randomized controlled trial with long-term follow-up. To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures.
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