[Value of orthopedic treatment of distal fractures of the forearm in children. Apropos of 152 cases].

PURPOSE OF THE STUDY: Distal forearm fractures in children are frequent. Management is conservative except in rare cases which will be discussed.

MATERIAL AND METHODS: Retrospective analysis of 152 distal forearm fractures after 10 and a half months (6 to 48 months) of follow-up was carried-out. Age ranged from 2 to 16 years (mean 10 years). Orthopaedic treatment was proposed in each case, but in 5, surgical treatment was required at onset. Clinical and radiological fracture reduction analysis was conducted immediately post op and during follow-up. 92 per cent of these fractures had a posterior or posterolateral angulation (with a mean angulation of 28 degrees 5). Among these cases, 64 per cent had instability criteria. Degree of translation when present (79 cases) was at 100 per cent in 55 cases (70 per cent); greater than 50 per cent in 11 cases (14 per cent) and less than 50 per cent in 13 cases (16 per cent). In 12 cases (8 per cent), the displacement was anterior with a degree of translation greater than 50 per cent in 6 cases and an angulation always greater than 30 degrees in the 6 remaining cases.

RESULTS: In 5 cases, surgical treatment was necessary due to initial instability and/or irreducibility. In 147 cases, analysis of instability criteria, reduction and cast quality, and of fracture location showed displacements in cases of non-adapted and incorrect X-ray work up (6 cases of 6); in 18 cases of 24 when the cast was adapted but with incorrect X-ray work-up; in 5 cases of 10 when the cast was non-adapted with correct X-ray work-up, in 3 cases of 7 when the fracture was superiorly located; and in 6 cases of 6 when cast was prematurely opened.

DISCUSSION: Close reduction is possible for fractures with large displacement but must be done perfectly and the cast must be adapted. If instability, irreducibility and/or incorrect reduction exist, management must include posterolateral and intrafocal percutaneous pinning, especially in older children. While rare, this indication must be known.