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Risk of Refracture in Proximal Both Bone Forearm Fractures among Skeletally Immature Patients
Alexander Aretakis, MD1, Zachary Clarke, MD1, Andy Lalka, MPH1, Aaron Brandt, MD2, Gaia Georgopoulos, MD1 and Sarah E Sibbel, MD3, (1)University of Colorado, Aurora, CO, (2)Johns Hopkins, Baltimore, MD, (3)University of Colorado School of Medicine, Aurora, CO

Pediatric patients with proximal both bone forearm fractures with increased angulation of the radius at union will have higher rates of refracture. We also evaluated if initial treatment strategy is associated with an increased need for re-reduction or additional refractures.
We performed a retrospective chart review of patients treated for a proximal both bone forearm fracture from January 2015 and December 2020 at a single level one pediatric hospital. Skeletally immature patients with open physes and a proximal one-third fracture of the radius with associated ulna fracture were included. Patients with less than three weeks follow-up, single bone fracture, missing radiographs, or midshaft, distal, and Monteggia fractures were excluded. We performed a Fisher’s exact test to evaluate the association of initial management strategy with refractures. A t-test compared radius angulation between refracture and no refracture groups. A logistic regression model evaluated the odds of refracture given lateral radius angulation deformity during follow-up.
We identified 113 patients with a mean age of 8.3 years (SD: 3.5), approximately 51% were male. Mean follow-up was 148 days. Initial management was appropriate in 77.9% of cases with only 22.1% of cases required additional treatment via cast wedging, closed re-reduction, or surgical intervention. There were 12 refractures (12.3%). Initial management strategies: splinting/casting in situ, closed reduction and casting, or surgical intervention, were not associated with risk of refracture (p=0.44). Mean radius angulation was higher among refractures at last follow up (18.2 degrees versus 6.9 degrees, p=0.04) among non-operatively treated patients. A radial fracture angulation of >7 degrees on the lateral XR was associated with a significantly increased risk of refracture (OR 8.14, 95%CI: CI 1.01-65.59, p=0.048).
Increasing angulation of the radius at union was significantly predictive of future refracture risk. Refracture risk was not associated with initial treatment strategy. Surgeons should consider a cutoff of 7 degrees for radial fracture angulation for nonoperative management.

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