BROAD SCORE: A tool for assessing reduction quality and predicting functional outcomes in paediatric diaphyseal both-bone forearm fractures

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-23 DOI:10.1016/j.jcot.2025.103071

Binoti Sheth, Kamal Jain, Pankaj Pawar

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引用次数: 0

Abstract

Background

Conservative management is the gold standard in the treatment of both bone forearm fractures in children. However, the guidelines for the same remain unclear. Acceptability of reduction and its maintenance in a cast are both important aspects of this management. Various casting indices have been described for the latter but no acceptability criterion has been considered as a standard. This study aimed to create a simple scoring system that would guide orthopaedicians in accepting a reduction, making informed decisions and explaining the outcomes to the patient and the caregivers.

Methods

40 children with both bone forearm fractures under the age of 9 were selected according to inclusion and exclusion criteria, closed reduction and above elbow casting was done and the patients prospectively followed up over a period of 1 year. Forearm radiographs were taken and range of motion (Flexion – Extension and Pronation - Supination) was documented at every visit. The BROAD Score (Bowing, Rotation, Overlap, Angulation, Displacement) was calculated at every visit and correlated with the range of motion and functional outcome grade as per Price criteria.

Results

57.5 % of the study population were aged 6–8 years (Male: Female = 5:3). Diaphyseal midshaft fractures were the most common (55 %). In patients with acceptable functional outcome (82.5 %, n = 33), the mean BROAD score immediately post reduction was 4.061 (±0.609), while in those with a fair/poor functional outcome (17.5 %, n = 7), the mean score was 2.643 (±0.626).

Conclusion

A BROAD score of at least 3.5 immediate post reduction, with a good casting technique and a meticulous follow up with radiographic evaluation would suffice to result in an acceptable functional outcome, provided there is enough time till skeletal maturity for remodeling. A score less than 3 should encourage the treating orthopaedician to consider re-manipulation in order to achieve a better outcome.

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BROAD SCORE：一个评估复位质量和预测儿科前臂骨干双骨骨折功能结局的工具

背景：保守治疗是治疗儿童前臂骨折的金标准。然而，这方面的指导方针仍不明确。减模的可接受性及其在铸件中的维持都是这种管理的重要方面。各种铸造指标已经描述了后者，但没有接受标准被认为是一个标准。本研究旨在建立一个简单的评分系统，指导骨科医生接受减量，做出明智的决定，并向患者和护理人员解释结果。方法选取40例9岁以下前臂双骨骨折患儿，按照纳入和排除标准，行闭合复位及肘部以上铸造，随访1年。每次就诊均拍摄前臂x线片，记录活动范围（屈曲-伸展和旋前-旋后）。每次就诊时计算BROAD评分（鞠躬、旋转、重叠、成角、位移），并根据Price标准与活动范围和功能结局分级相关。结果57.5%的研究人群年龄在6-8岁（男：女= 5:3）。骨干中轴骨折最为常见（55%）。在功能预后可接受的患者中（82.5%,n = 33），术后立即的BROAD平均评分为4.061（±0.609），而在功能预后一般/较差的患者中（17.5%,n = 7），平均评分为2.643（±0.626）。结论立即复位后的BROAD评分至少为3.5分，加上良好的铸造技术和细致的影像学随访评估，只要有足够的时间到骨骼成熟进行重塑，就足以产生可接受的功能结果。得分低于3分应鼓励治疗骨科医生考虑再操作，以获得更好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.