Description
- Abstract:
- In pediatric patients with closed both-bone forearm fractures (BBFFs), decisions between conservative management (i.e., reduction and casting) and surgical intervention can be challenging, as one must balance the inherent instability of both bone fractures against the remodeling capacity of pediatric bone. A systematic review was conducted according the PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Cochrane, Embase, and Web of Science to identify original articles that assessed clinical and/or radiographic parameters contributing to failure of nonoperative management in pediatric patients with diagnosed closed BBFFs, where at least one bone had a complete fracture. Treatment failure was defined as loss of reduction (LOR) during immobilization period or need for additional intervention including manipulation or surgery. A total of 226 articles were initially identified; 9 studies were included in the final analysis, encompassing 1167 pediatric patients with both bone fractures that were initially treated with conservative management. Of this cohort, 326 (28% of cohort) patients failed initial conservative management. Key predictors of treatment failure that were reported included patients age >10 years, pre-reduction translation >50%, and post-reduction translation >20-50%. Proximal third fractures may warrant more increased attention and follow up due to longer healing times and less remodeling capacity. Post-reduction angulation may be helpful in monitoring LOR risk and loss in range of motion. However, due to contradictory findings from included articles, more evidence is needed to provide concrete cut offs that can be used to guide clinical decision making. Review of the literature demonstrated stark heterogeneity across the literature regarding when acceptable reduction is achieved and whether to transition to surgical treatment. Guidelines that consider patient and fracture characteristics are needed to inform physician treatment decisions and improve counseling for patients and their families during this period of pain and critical development.
- Notes:
- Scholarly concentration: Medical Technology, Innovation and Entrepreneurship
Access Conditions
- Use and Reproduction
- All rights reserved
- Rights
- In Copyright
- Restrictions on Use
- All Rights Reserved
Citation
Li, Nina S., Liu, Joanne Z., Ahn, Sophia, et al.,
"Predictors of Failed Conservative Management in Pediatric Both Bone Fractures: A Systematic Review of Literature"
(2025).
Warren Alpert Medical School Academic Symposium.
Brown Digital Repository. Brown University Library.
https://repository.library.brown.edu/studio/item/bdr:du5r6dg7/
Relations
Collection:
-
Warren Alpert Medical School Academic Symposium
The Warren Alpert Medical School Academic Symposium is an annual event at Warren Alpert Medical School of Brown University that provides Year II medical students a venue to present their summer research in a poster format. Participation in the Symposium …...