Factors affecting remanipulation in paediatric forearm fractures.

Abstract

Children's forearm fractures treated in plaster after closed reduction can redisplace and require remanipulation. A retrospective review of 164 consecutive manipulations of fractures of radius and ulna in theatre over a 3-year period was carried out. After various exclusions, 114 patients entered the study. The overall rate of remanipulation was 14.04% (16 children). Presence of preoperative translation deformity predisposed to loss of position in plaster (P<0.0001). Residual deformity on intraoperative films also had a strong adverse influence on the outcome (P = 0.001). Usage of below-the-elbow plaster in distal fractures (P = 0.840), having a low cast index (P = 0.538), fracture of both radius and ulna (P = 0.248), site of the fracture (P = 0.048, not significant on logistic regression) or surgeon grade (P = 0.744) did not have any significant bearing on the rate of manipulation. We propose that fractures with preoperative translation where anatomical reduction is not achieved should be fixed internally.