Intramedullary osteosynthesis for pediatric forearm re-fractures depending on the time of occurrence

Background Tactical and technical errors in repair of pediatric forearm fractures can be associated with various complications including refractures. There are many questions regarding diagnosis (osteoreparation at the time of the occurrence) and in surgical treatment.

The objective was to improve outcomes of pediatic forearm refractures treated with intramedullary osteosynthesis considering a osteoreparation period and the time of the occurrence.

Material and methods There were 48 children with forearm refractures treated in the clinic between 2010 and  2020. The patients were divided into two groups. Patients of group 1 (n = 25) were treated with intramedullary osteosynthesis neglecting the regenerative process and the timing of refracture relative to  the  primary fracture. Patients of group 2 (n = 23) sustained a recurrent fracture at 6 months of early osteoregeneration with developing callosity. Re-fracture occurred in 19 (76.0 %) patients of group 1 including six children (24 %) with two or greater occurrences. Recurrence was observed in 16 (69.6 %) cases of group 2 including seven patients (30.4 %) who sustained more than two fractures.

Results The timing of re-fractures, immobilization and gradual removal of fixation components can facilitate improved short- and long-term results of surgical treatment and prevent complications that were evident in 22 (95.6 %) children of group 2 with good results observed at 6 months.

Discussion The calluses were replete with blood vessels indicating the normal regeneration for fractures that  occurred at 6 months of the initial fracture. No vessels in the callus were seen after 6 months due to resorption of the bundles and poor fracture healing.

Conclusion The outcome of re-consolidation would be dependent on the stage of bone regeneration at the time of forearm refracture. The regeneration process was more effective in the early stage of re-fracture.

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