Imaging of and clinical findings concerning children’s non-operatively treated distal forearm fractures, and shaft fractures treated with biodegradable implants.

This thesis aimed to evaluate the current treatment practices of children’s forearm fractures. Fractures of the forearm represent a significant proportion of injuries in childhood, accounting for up to 40% of all fractures among children under 16. The considerable potential for remodelling of distal forearm fractures often advocates for non-operative treatment. However, solid criteria to determine acceptable fracture alignment remain elusive. Conversely, diaphyseal forearm fractures possess reduced remodelling capacity, obviating operative intervention more frequently. The golden standard operative treatment of forearm shaft fractures in children is intramedullary nailing.
One hundred consecutive paediatric patients were retrospectively evaluated to detect deterioration in the alignment of non-operatively treated distal forearm fractures, which are prone to displacement. Predetermined radiographic criteria ‘strict’ and ‘wide’ were used to define the limits of acceptable alignment. Accordingly, the rate of splint repair or renewal was also assessed. A randomised controlled trial was performed to assess the late clinical outcomes of paediatric patients with operative treatment by either elastic stable intramedullary nails (ESIN) or biodegradable intramedullary nails (BIN) for forearm shaft fractures. Additionally, the biodegradation of the BINs and the soft tissue reactions in the distal radius were assessed by magnetic resonance imaging (MRI).
Literature based, age-proportional limits (strict and wide) of displacement for acceptable alignment in distal forearm fractures indicated a loss of reduction during follow-up in 2% and 19% of patients, respectively. In real life, only one patient was retreated during the follow-up. Thirty-two per cent of the patients needed some intervention due to splint loosening or failure. The use of strict radiographic displacement criteria alone may increase the number of unnecessary interventions and follow-up appointments for fractures with a high remodelling potential. Clinical follow-up is justified due to the high rate of splint-related incidents.
There was no clinically significant difference between the long-term recovery of the patients treated with the BIN and those treated with the ESIN for forearm shaft fractures. The biodegradable nails were completely or almost completely degraded according to the MRI taken four to eight years after their implementation without adverse effects. The applicability of the BIN in the treatment of teenagers’ forearm fractures needs further evaluation, because two teenaged patients had lost fracture reduction in the early course of the treatment.