Functional and Radiological Outcome of Conservatively Managed Fracture of Radius and Ulna Forearm Bone in Paediatric PopulationA Longitudinal Interventional Study

Abstract

Introduction: Fractures of the shaft of both bones of forearm are one of the most common fractures in the paediatric age group. There is often a difference of opinion regarding the management of these fractures. Though, there has been an increasing inclination towards surgical correction of these injuries, conservative management is still very popular because of the advantage of good bone remodelling potential in children. Loss of reduction is a known complication of conservative method of treatment. Assessment of the cast index can serve as a tool for the prediction of failure of the conservative management. Aim: To analyse the functional and radiological outcomes of both radius and ulna forearm bones shaft fractures. Materials and Methods: This longitudinal interventional study was conducted in the Department of Orthopaedic Surgery, at King George’s Medical University, Lucknow, Uttar Pradesh, India. The duration of the study was one year 11 months, from June 2017 to May 2019. A total of 196 (156 males and 40 females) patients were included in the study, who presented with closed diaphyseal fractures of the radius and ulna, and were managed conservatively. The patients with acceptable reductions were followed-up at three weeks, six weeks, three months and six months. The functional and radiological parameters were assessed, analysed and the cast index was estimated at each follow-up visit. Chi-square test was performed on the numerical/frequency displays of the dichotomous variables. Student’s t-test with a 95% confidence interval was performed to compare the means of the two groups. Results: The changes in angulation for Anteroposterior (AP), as well as, lateral view of both radius and ulna were significant at each follow-up (p<0.001), but the fracture reduction was found acceptable as per protocol. The loss of reduction was seen equally in male and female patients, only on the left-side and only in the middle third of both bone forearm fracture, but no significant association was found between sex, laterality, site and loss of reduction. The final Range Of Motion (ROM) obtained at elbow, forearm and wrist were all in the functional range at six months follow-up. There were two cases of failure, both above 10 years of age having high cast index and greater angulation in ulna in the prereduction phase. Conclusion: Conservative treatment remains the gold standard for management of paediatric bones forearm fractures with very good functional outcome. A high cast index can be used to predict failure of the conservative management.