Pediatric forearm fractures in the Emergency Department: a retrospective comparative analysis

Objective
Forearm fractures are common pediatric traumas in the Emergency Department (ED), however treatment remains controversial. The goal of this study was to evaluate treatment decisions of pediatric forearm fractures in the ED, comparing outcomes of fractures reduces in the ED versus those reduced in the operating room (OR).
Methods
In a retrospective 5-year-study all children (0-18 years) with closed fractures of both forearm bones presenting at the ED were included. Data collected included patient demographics, fracture details, radiographs, time of diagnosis and treatment. The primary outcome was reduction success rate. Factors associated with the decision to reduce fractures in both ED and OR were analyzed using logistic regression.
Results
In total 270 patients were included, of which 124 forearm fractures (45.9%) were reduced. Fifty-six (45.2%) fractures were reduced in the ED with a 93% success rate, and 68 (54.8%) in the OR with a 100% success rate. Factors associated with reduction included: complete fracture (OR 20.474; 95% CI 7.711-54.362), higher initial angulation of radius (OR 1.186; 95% CI 1.105-1.273) and ulna (OR 1.105; CI 95% 1.040-1.174). Reduction in the OR yielded superior outcomes compared to the ED, with higher percentages in acceptable post-reduction position (94.1% vs 78.6%, p<0.001), acceptable position end of treatment (88.3% vs 69.6%, p<0.001) and rate of reduction (85% vs 68%, p<0.010). Complete forearm fracture is associated with the decision for reduction in the OR (OR 3.810; 95% CI 1.121-12.944). The mean time between diagnosis and treatment differed significantly between ED and OR (123,50 minutes vs 1000,50 minutes, p<0.001), favoring the ED.
Conclusion
The results of this study show a success rate of reduction in the ED > 90%. Higher initial angulation and complete fractures indicate the need for reduction. Despite superior outcomes in the OR, we recommend ED treatment for pediatric forearm fractures requiring reduction when feasible, offering less invasiveness (patients and parents), reducing hospital time (cost-effective) while achieving good results.