Open AccessEvidence-based Medicine
Author(s) -
Corinna Franklin,
Jonathan Robinson,
Kenneth Noonan,
John M. Flynn
Publication year - 2012
Publication title -
journal of pediatric orthopaedics/journal of pediatric orthopedics
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 1.318
H-Index - 96
eISSN - 1539-2570
pISSN - 0271-6798
DOI - 10.1097/bpo.0b013e318259543b
Subject(s) - medicine , intramedullary rod , forearm , surgery , complication , reduction (mathematics) , fixation (population genetics) , evidence based medicine , orthopedic surgery , population , geometry , mathematics , environmental health , alternative medicine , pathology
Forearm fractures are common injuries in the pediatric population. Successful treatment of these fractures should result in complication-free functional pronosupination. Traditionally, these have been treated with closed reduction and casting, but the last several decades have seen a dramatic increase in the operative treatment of these fractures. However, little high-level evidence exists to guide management. The data from the limited set of studies available suggest that closed treatment does usually result in satisfactory outcomes, particularly in younger patients; operative fixation is usually successful as well but comes with a significantly increased complication rate. The ideal study to aid in evidence-based decision-making for pediatric forearm fractures would be a randomly controlled trial comparing closed reduction and casting versus intramedullary nailing versus plating; in children ranging from 8 years old to skeletally mature; with closed forearm fractures, complete or greenstick with >20 degrees of angulation; with a minimum of 5 years of follow-up (or to maturity); with the primary outcome defined as final pronation and supination; using an validated functional outcome tool; and precisely defining the complications from each treatment.