Characteristics and treatment outcomes of forearm shaft fractures among paediatric patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Paediatric diaphyseal fractures of the radius and ulna are the third most common fractures in the paediatric population, accounting for 13-40% of all paediatric fractures. Treatment of paediatric forearm shaft fractures in most cases is by closed reduction and immobilization with favourable outcome. Published studies on the characteristics and treatment outcomes of paediatric forearm shaft fractures are scarce regionally. Objective: To describe the characteristics and treatment outcomes of paediatric forearm shaft fractures at Moi Teaching and Referral Hospital (MTRH). Methods: This was a prospective descriptive study conducted at Moi Teaching and Referral Hospital from August 2018 to July 2019. All patients aged fourteen years and below diagnosed with forearm shaft fractures were recruited after obtaining consent. Approval was obtained from Institutional Research and Ethics Committee; and from Moi Teaching and Referral Hospital. A total of 121 children participated in the study. Data on socio-demographics, fracture pattern, treatment and outcome were collected using interviewer based questionnaire. Follow up was done at 4,8,12 and 24 weeks. Descriptive statistics including frequencies and percentages were used for categorical variables while measures of central tendency and measures of spread were used for continuous variables. Chi-square and Fisher’s exact tests were used to assess the association between categorical variables. The quality of initial reduction was assessed as anatomical, good, fair and poor reduction using Asadollahi et al., 2017 criteria. Clinical outcome was determined as excellent, fair and poor using Flynn et al., 2010 criteria. Results: The mean age of the participants was 8.6 years (SD=4.7) with a range of 1 and 14 years. Males were more commonly affected than females (65% vs35%). The most common mechanism of injury for patients aged 1-5 years and 5- 10 years was a fall and was at 77.4% and 63.8% respectively, while sports (77.4%) was the commonest cause of injury for children aged 10-14 years (p-value <0.001). Most children had greenstick fractures (67.8%) and the distal third of the radius/ulna shaft was the commonest site of fracture (53.7%). Ninety three percent of the patient had anatomical/good reduction on the initial post-reduction radiograph and were managed non-operatively using sugartong splint. Seven percent of the patient had fair/poor reduction on initial post-reduction radiograph and developed re-displacement on follow up and were operated. Percutaneous intramedullary K-wiring was the operative method used. Re-displacement occurred in 6.6% of patients after closed reduction and immobilization. Following nonoperative treatment, 98.2% of the patients had an excellent result and 1.8% had fair result (p-value <0.002). In the operated cases, 62.5% were done closed reduction and percutaneous pinning and had an excellent outcome, while 37.5% were done open reduction and percutaneous pinning and had fair outcome. Conclusion: Males were more commonly affected than females. Fall was the commonest mechanism of injury. Non-operative management using sugar-tong splint was effective treatment for forearm shaft fractures in children. A non-anatomical alignment on the initial post-reduction radiograph was a high risk factor for redisplacement. Recommendation: Non-operative management of forearm shaft fractures is recommended. Further study is needed on factors contributing to re-displacement of forearm shaft fractures in children managed conservatively.