Angulated fractures of the distal forearm in children: is remodeling a therapeutic option? (AFIC)

• Applicant: Professor Dr. Lucas Wessel
• Subject Area: Pediatric and Adolescent Medicine
• Term: from 2013 to 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 223330012

Incomplete greenstick fractures and complete fractures without shortening of the distal forearm in children less than 10 yrs of age are very frequent lesions. Therapy of angulated fractures is matter of intensive debate. Despite reduction and/or pinning, redislocation results in at least 30% of cases. Yet, the distal physis of the forearm possesses immense remodelling capacity leading to reliable correction of malalignment in the next two posttraumatic years. In Germany no standardized protocol for the treatment of these fractures exists. Primary manipulation and pinning in general anaesthesia is recommended in order to avoid malalignment. It is hypothesized that in children less than 10 yrs of age malalignment of 20° in both sagittal and frontal plane in distal forearm fractures will be corrected spontaneously by remodelling during further growth. Two years post trauma functional and radiological results are similar after immobilization alone or reduction and K-wire pinning. In this study angulated fractures up to 20° will be treated without manipulation in plaster and compared to manipulation, pinning and plaster. Remodelling over 2 yrs will be determined. Incidence of these fractures is 25% of all paediatric fractures in any institution. They are representative for this age group. Primary endpoint is the Cooney-Score, a validated score for wrist lesions in children and adults. Secondary endpoints are persistent radiological malalignment, therapeutic complications, remanipulations and growth disturbance. Should remodelling appear to be a safe alternative, manipulation under general anaesthesia, K-wire pinning and removal of pins under anaesthesia could be avoided, thus sparing relevant costs.

• DFG Programme: Clinical Trials
• Participating Persons: Dr. Kai Kronfeld; Dr. Dirk W. Sommerfeldt