Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis
ABSTRACT: Background: The well accepted standard for the management of pediatric both bone forearm fractures (BBFFs) is closed reduction and cast management. The acceptable angulation guidelines, dictated by patient age and fracture location, help determine when nonsurgical management should be aba...
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Elsevier
2024-02-01
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| Series: | Journal of the Pediatric Orthopaedic Society of North America |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2768276524000130 |
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| author | K. Aaron Shaw, DO Adam Jamnik, MD Luke Shiver, MD Keegan Kronenberger Hilary Harris Robert Burks, PhD Nicholas D. Fletcher, MD |
| author_facet | K. Aaron Shaw, DO Adam Jamnik, MD Luke Shiver, MD Keegan Kronenberger Hilary Harris Robert Burks, PhD Nicholas D. Fletcher, MD |
| author_sort | K. Aaron Shaw, DO |
| collection | DOAJ |
| description | ABSTRACT: Background: The well accepted standard for the management of pediatric both bone forearm fractures (BBFFs) is closed reduction and cast management. The acceptable angulation guidelines, dictated by patient age and fracture location, help determine when nonsurgical management should be abandoned. Despite their widespread acceptance, angulation guidelines are not evidence-based and have not been critically investigated within the reported literature. Methods: A systematic review and metanalysis was performed after isolating published articles from 1967 to 2021 from a review of MEDLINE, Embase, EBSCO, and Cochrane databases. Articles which reported on closed management of midshaft, pediatric (<16 years old), BBFF, and reported on long term outcomes regarding range of motion restriction or the need for surgical treatment of symptomatic malunion, were included in the systematic review. Pertinent patient data for meta-analysis was extracted from individual studies when feasible. Univariate and multivariate analyses were performed examining the effect of fracture angulation parameters on malunion risk. Results: A total of 11 articles were included which reported on the management of 372 patients with midshaft BBFF. Overall, there was a 15.0% rate of symptomatic malunion (N = 47/313). The pooled analysis using individual data from 81 patients reported in 6 studies demonstrated an 18.8% (N = 16) rate of symptomatic malunion with only final radius angulation on lateral radiographs ≥15° as an independent risk factor for symptomatic malunion development. Conclusions: Although this study would appear to support current acceptable angulation parameters for pediatric midshaft BBFF and the risk for symptomatic malunion development, there was a paucity of available data that precluded a rigorous analysis. Further high-quality research is needed to ascertain if our currently accepted guidelines are indeed best practice guidelines or the representation of confirmation bias in practice. Key Concepts: (1) Although pediatric midshaft bone forearm fracture remain an important component of pediatric orthopedic practice, there is a lack of rigorous data available to guide treatment decisions. (2) In this study only 5 of 84 potential studies met inclusion criteria to accessing the rate of symptomatic malunion, resulting in a pooled malunion rate of 18.8%. (3) Of the potential variables, only final sagittal radius alignment >15° was significantly associated with the development of a symptomatic malunion. Level of Evidence: II |
| format | Article |
| id | doaj-art-1d1e9c90f5444059a983ae6654251bf5 |
| institution | Kabale University |
| issn | 2768-2765 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Pediatric Orthopaedic Society of North America |
| spelling | doaj-art-1d1e9c90f5444059a983ae6654251bf52024-11-21T06:06:45ZengElsevierJournal of the Pediatric Orthopaedic Society of North America2768-27652024-02-016100013Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysisK. Aaron Shaw, DO0Adam Jamnik, MD1Luke Shiver, MD2Keegan Kronenberger3Hilary Harris4Robert Burks, PhD5Nicholas D. Fletcher, MD6Department of Pediatric Orthopaedics, Children’s Mercy Hospital, Kansas City, MO, USA; Corresponding author: Department of Orthopaedic Surgery, Children’s Mercy Hospital, Kansas City, MO, USA.Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USADepartment of Orthopaedic Surgery, Augusta University, Augusta, GA, USADepartment of Pediatric Orthopaedic Surgery, Childrens Healthcare of Atlanta at Emory University, Atlanta, GA, USADepartment of Pediatric Orthopaedic Surgery, Childrens Healthcare of Atlanta at Emory University, Atlanta, GA, USADepartment of Defense Analysis, Naval Postgraduate School, Monterey, CA, USADepartment of Pediatric Orthopaedic Surgery, Childrens Healthcare of Atlanta at Emory University, Atlanta, GA, USAABSTRACT: Background: The well accepted standard for the management of pediatric both bone forearm fractures (BBFFs) is closed reduction and cast management. The acceptable angulation guidelines, dictated by patient age and fracture location, help determine when nonsurgical management should be abandoned. Despite their widespread acceptance, angulation guidelines are not evidence-based and have not been critically investigated within the reported literature. Methods: A systematic review and metanalysis was performed after isolating published articles from 1967 to 2021 from a review of MEDLINE, Embase, EBSCO, and Cochrane databases. Articles which reported on closed management of midshaft, pediatric (<16 years old), BBFF, and reported on long term outcomes regarding range of motion restriction or the need for surgical treatment of symptomatic malunion, were included in the systematic review. Pertinent patient data for meta-analysis was extracted from individual studies when feasible. Univariate and multivariate analyses were performed examining the effect of fracture angulation parameters on malunion risk. Results: A total of 11 articles were included which reported on the management of 372 patients with midshaft BBFF. Overall, there was a 15.0% rate of symptomatic malunion (N = 47/313). The pooled analysis using individual data from 81 patients reported in 6 studies demonstrated an 18.8% (N = 16) rate of symptomatic malunion with only final radius angulation on lateral radiographs ≥15° as an independent risk factor for symptomatic malunion development. Conclusions: Although this study would appear to support current acceptable angulation parameters for pediatric midshaft BBFF and the risk for symptomatic malunion development, there was a paucity of available data that precluded a rigorous analysis. Further high-quality research is needed to ascertain if our currently accepted guidelines are indeed best practice guidelines or the representation of confirmation bias in practice. Key Concepts: (1) Although pediatric midshaft bone forearm fracture remain an important component of pediatric orthopedic practice, there is a lack of rigorous data available to guide treatment decisions. (2) In this study only 5 of 84 potential studies met inclusion criteria to accessing the rate of symptomatic malunion, resulting in a pooled malunion rate of 18.8%. (3) Of the potential variables, only final sagittal radius alignment >15° was significantly associated with the development of a symptomatic malunion. Level of Evidence: IIhttp://www.sciencedirect.com/science/article/pii/S2768276524000130PediatricBoth bone forearm fractureAcceptable angulationMetanalysis |
| spellingShingle | K. Aaron Shaw, DO Adam Jamnik, MD Luke Shiver, MD Keegan Kronenberger Hilary Harris Robert Burks, PhD Nicholas D. Fletcher, MD Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis Journal of the Pediatric Orthopaedic Society of North America Pediatric Both bone forearm fracture Acceptable angulation Metanalysis |
| title | Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis |
| title_full | Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis |
| title_fullStr | Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis |
| title_full_unstemmed | Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis |
| title_short | Acceptable angulation criteria in pediatric midshaft forearm fractures: A systematic review and meta-analysis |
| title_sort | acceptable angulation criteria in pediatric midshaft forearm fractures a systematic review and meta analysis |
| topic | Pediatric Both bone forearm fracture Acceptable angulation Metanalysis |
| url | http://www.sciencedirect.com/science/article/pii/S2768276524000130 |
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