Risk Factors for Failure of Closed Forearm Fracture Reduction in the Pediatric Emergency Department

Neta Cohen*, Roy Gigi, Shira Haberman, Tali Capua, Ayelet Rimon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objectives This study aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED) and to suggest indications for initial surgery. Methods This retrospective cohort study included all patients aged 0 to 18 years who presented to our pediatric ED with an extraarticular forearm fracture treated with closed reduction between May 2017 and April 2021. We explored risk factors for procedural failure, defined as a need for surgical intervention within 6 weeks of the closed reduction attempt. Results Of 375 patients (median age 8.1 years, 294 [78.2%] boys), 44 (11.7%) patients sustained a reduction failure, of whom 42 (95.5%) had both radius and ulna fractures. Of the 259 patients with fractures of both bones, the following parameters were independent predictors for reduction failure: refracture (adjusted odds ratio [aOR] 17.6, P < 0.001), open fracture (aOR 10.1, P = 0.007), midshaft fracture (aOR 2.6, P = 0.004), radial translation rate 37% and higher in either plane (aOR 5.1, P = 0.004), and age of 10 years and older (aOR 2.9, P = 0.01). Conclusions Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. Refracture, open fracture, midshaft location, initial radius bone translation of 37% and higher (and not initial angulation), and patient age of 10 years and older are independent risk factors for reduction failure in two-bone fractures. We propose a risk score for reduction failure that can serve as a decision-making tool.

Original languageEnglish
Pages (from-to)702-706
Number of pages5
JournalPediatric Emergency Care
Volume39
Issue number9
DOIs
StatePublished - 1 Sep 2023

Keywords

  • closed reduction
  • forearm fracture
  • surgical intervention

Fingerprint

Dive into the research topics of 'Risk Factors for Failure of Closed Forearm Fracture Reduction in the Pediatric Emergency Department'. Together they form a unique fingerprint.

Cite this