Risk factors for forearm re-fracture in children

BACKGROUND: The purpose of this study was to estimate the clinical and radiologic risk factors that may predispose to radio and ulna re-fractures in children.METHODS: In this retrospective study, forearm re-fractures treated from January 2017 to December 2022 in a single pediatric orthopedic center were reviewed. Criteria of inclusion was age younger than 14 years old while criteria of exclusion were the presence of neuromuscular or genetic conditions, metabolic diseases, and pathologic fractures. Sex, age, type of treatment, time elapsed between fractures, immobilization and return to sport timings were recorded. Fracture location, dislocation angles and time to radiographic bones healing were evaluated.RESULTS: Twenty-nine patients underwent a re-fracture and met the inclusion criteria. The average time of immobilization after the index fracture was 48.7 days. The 44.8% of patients had a residual angulation >10 degrees in lateral radiographic planes at the time of last X-ray of the index fracture. Patients returned to physical activities after a mean of 70 days since the index fracture. The average time to refracture was 100 days since the end of immobilization.CONCLUSIONS: The most important risk factors for refracture are residual volar angulation of radio and ulna, short term immobilization and early return to sport activities. Therefore, we suggest that borderline angulations should be addressed; we recommend immobilization for 8 weeks, followed by gradual mobilization and we suggest avoiding sport for three months in order to reduce the refracture risk.