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      Navigating Challenges and Treatment Options in Diaphyseal Forearm Fractures Among Adolescents: Case Series and Narrative Review

      case-report
      1 ,
      ,
      Cureus
      Cureus
      hybrid method, double plate, intramedullary nails, re-fractures, fractures in children, forearm diaphyseal fractures

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          Abstract

          In this paper, we recount the medical trajectories of two male patients, both fourteen years of age, who sustained re-fractures of their radius and ulna six months post their primary diaphyseal fractures. Owing to the limited capacity for growth of the forearm bones between the ages of ten to sixteen years, many queries are engendered concerning apt treatment strategies. The pressing questions are whether these should be conservative or surgical and the precise method to be employed in surgical interventions. This discourse endeavors to demarcate preferred therapeutic options and shed light on a series of standard clinical dilemmas physicians encounter, along with an exhaustive scrutiny of existing literature.

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          Most cited references24

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          Epidemiology of Pediatric Fractures Presenting to Emergency Departments in the United States.

          Fractures in children are an important public health issue and a frequent cause of emergency room visits. The purpose of this descriptive epidemiological study was to identify the most frequent pediatric fractures per 1000 population at risk in the United States using the 2010 National Electronic Injury Surveillance System (NEISS) database and 2010 US Census information.
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            Forearm and distal radius fractures in children.

            Pediatric forearm and distal radius fractures are common injuries. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational displacement. Fractures are classified by location, completeness, angular and rotational deformity, and fragment displacement. Successful outcomes are based on restoration of adequate pronation and supination and, to a lesser degree, acceptable cosmesis. When several important concepts are kept in mind, these goals are usually met with conservative treatment by reduction and immobilization. Greenstick fractures are reduced by rotating the forearm such that the palm is directed toward the fracture apex. Complete fractures are manipulated and reduced with traction and rotation; extremities are then immobilized in well-molded plaster casts until healing, which usually takes about 6 weeks. Radiographs should be obtained between 1 and 2 weeks after initial reduction to detect early angulation. In fractures in any level in children less than 9 years of age, complete displacement, 15 degrees of angulation, and 45 degrees of malrotation are acceptable. In children 9 years of age or older, 30 degrees of malrotation is acceptable, with 10 degrees of angulation for proximal fractures and 15 degrees for more distal fractures. Complete bayonet apposition is acceptable, especially for distal radius fractures, as long as angulation does not exceed 20 degrees and 2 years of growth remains. Operative intervention is used when the fracture is open and when acceptable alignment cannot be achieved or maintained. Single-bone intramedullary fixation has proven useful.
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              Nonoperative treatment of both-bone forearm shaft fractures in children: predictors of early radiographic failure.

              Forearm shaft fractures are the third most common fracture in children. Although closed reduction and casting is the preferred treatment; outcomes remain variable. The purpose of this study was to identify factors associated with failure of nonoperative treatment for pediatric complete forearm shaft fractures and to explore the time frame in which failure is likely.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                19 June 2023
                June 2023
                : 15
                : 6
                : e40669
                Affiliations
                [1 ] Orthopaedics, Osaka Red Cross Hospital, Osaka, JPN
                Author notes
                Article
                10.7759/cureus.40669
                10356996
                34f1048a-fe6f-4ec8-a2de-d1b07c0127ed
                Copyright © 2023, Yoshiyama et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 June 2023
                Categories
                Orthopedics
                Trauma

                hybrid method,double plate,intramedullary nails,re-fractures,fractures in children,forearm diaphyseal fractures

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