Angular malalignment as cause of limitation of forearm rotation: An analysis of prospectively collected data of both-bone forearm fractures in children

Introduction Although limitation of pronation/supination following both-bone forearm fractures in children is often attributed to an angular malunion, no clinical study has compared pronation/supination and angular malalignment of the same child by analysis of prospectively collected clinical data. Aim The purpose of this trial is to explore whether limitation of pronation/supination can be predicted by the degree of angular malalignment in children who sustained a both-bone forearm fracture. Methods In four Dutch hospitals, children aged ≤16 years with a both-bone forearm fracture were prospectively followed up consecutive children for 6-9 months. At the final follow-up, pronation/supination and angular malunion on radiographs were determined. Results Between January 2006 and August 2010, a total of 410 children were prospectively followed up, of which 393 children were included for analysis in this study. The mean age of the children was 8.0 (3.5) years, of which 63% were male and 40% fractured their dominant arm. The mean time to final examination was 219 (51) days. Children with a metaphyseal both-bone fracture of the distal forearm with an angular malalignment of ≤15°had a 9-13% chance of developing a clinically relevant limitation (i.e., <50°of pronation and/or supination), while children with an angular malalignment of ≥16°had a 60% chance. Children with diaphyseal both-bone forearm fractures with ≤5degof angular malalignment had a 13% chance of developing a clinically relevant limitation, which showed no significant increase with a further increase of angular malalignment. Conclusions Children who sustained a both-bone forearm fracture localised in the distal metaphysis have a higher chance of developing a clinically relevant limitation of forearm rotation in case of a more severe angular malalignment, while children with a diaphyseal both-bone forearm fracture had a moderate chance of limitation, irrespective of the severity of the angular malalignment. ;copy: 2014 Elsevier Ltd.

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