Proximal both-bone forearm fractures in children: factors predicting outcome

Background: The literature is replete with outcomes studies on pediatric forearm fractures; however, information concerning the outcomes of both-bone fractures of the proximal radius and ulna is limited. The purpose of our study was to evaluate the prognosis and outcomes in children with combined fractures of the proximal radius and ulna, with special attention to complications. Methods: A single-center, retrospective study identified patients ages 3 to 15yr old with proximal forearm fractures treated between January of 1994 and February of 2014. Patients were excluded if they did not have both-bone fractures of the proximal forearm. Records were reviewed with a focus on outcomes and their association with age at the time of injury, severity of injury, type of treatment, and complications. Results: Thirty-one patients met the inclusion criteria. Significant differences were seen between patients younger than 10 yr of age and patients older than 10 yr of age in rates of requiring operative treatment (P= 0.048) and returning to the operating room (P= 0.037) There was no significant difference in nerve injury (P= 0.519) or range-of-motion deficits (P= 0.872) based on age. In addition, no difference was seen in range-of-motion deficits based on severity of injury as determined by displacement (complete or none) (P= 0.139). Conclusions: Most proximal both-bone forearm fractures in children, including olecranon and radial neck fractures, Monteggta type IV fractures, and nonspecific proximal both-bone forearm fractures, have good-to-excellent results. In our study, older age, defined as lOyr of age or older at the time of injury, resulted in more frequent need for operative intervention, a higher rate of return to the operating room and greater risk of nerve injury. The older children were not more likely to have range of motion deficits despite a more involved course, which contradicts previous reports, and older age at the time of injury did not necessarily predict poorer outcomes.