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

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.