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Archives of Orthopaedic and Trauma Surgery

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01-03-2014 | Orthopaedic Surgery

Three-dimensional imaging of children with severe limitation of pronation/supination after a both-bone forearm fracture

Authors: Joost W. Colaris, Stanley Oei, Max Reijman, Herma Holscher, Jan Hein Allema, Jan A. N. Verhaar

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2014

Abstract

Introduction

Although both-bone forearm fractures in children may result in severe limitation of forearm rotation, finding the cause remains a diagnostic challenge. This study tries to evaluate the role of rotational malunion, bony impingement and contractures of the interosseous membrane.

Patients and methods

Children (5–16 years) who suffered from a both-bone forearm fracture in diaphysis or distal metaphysis with a limitation of pronation/supination ≥40° at ≥6 months after trauma were included for analysis with conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI).

Results

A total of 410 children with a both-bone forearm fracture were prospectively followed in four Dutch hospitals. At a median of 205 days, 7.3 % suffered from a limitation of pronation/supination ≥40°. 14 children were included (median limitation of 40°) and the radiographs revealed a median maximum angular malunion of 16°. CT analysis showed rotational malunion of both radius (median 19°) and ulna (median 9°). MRI analysis revealed neither bony impingement nor contractures of the interosseous membrane.

Conclusions

Three-dimensional imaging of children with a severe limitation of pronation/supination after a both-bone forearm fracture revealed rotational malunions of both radius and ulna without bony impingement or soft tissue contractures.

Level of evidence

Prospective multicenter study, Level 2.

Colaris JW, Allema JH, Biter LU, de Vries MR, van de Ven CP, Bloem RM et al (2013) Re-displacement of stable distal both-bone forearm fractures in children: a randomised controlled multicentre trial. Injury 44(4):498–503PubMedCrossRef

Colaris JW, Biter LU, Allema JH, Bloem RM, van de Ven CP, de Vries MR et al (2012) Below-elbow cast for metaphyseal both-bone fractures of the distal forearm in children: a randomised multicentre study. Injury 43(7):1107–1111PubMedCrossRef

Colaris JW, Reijman M, Allema JH, Biter LU, Bloem RM, van de Ven CP, et al (2013) Early conversion to below-elbow cast for non-reduced diaphyseal both-bone forearm fractures in children is safe: preliminary results of a multicentre randomised controlled trial. Arch Orthop Trauma Surg 133(10):1407–1414

Colaris J, Reijman M, Allema JH, Kraan G, van Winterswijk P, de Vries M, et al (2013) Single-bone intramedullary fixation of unstable both-bone diaphyseal forearm fractures in children leads to increased re-displacement: a multicentre randomised controlled trial. Arch Orthop Trauma Surg 133(8):1079–1087

Bronstein AJ, Trumble TE, Tencer AF (1997) The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg Am 22(2):258–262PubMedCrossRef

Dumont CE, Thalmann R, Macy JC (2002) The effect of rotational malunion of the radius and the ulna on supination and pronation. J Bone Joint Surg Br 84(7):1070–1074PubMedCrossRef

Kasten P, Krefft M, Hesselbach J, Weinberg AM (2003) How does torsional deformity of the radial shaft influence the rotation of the forearm? A biomechanical study. J Orthop Trauma 17(1):57–60PubMedCrossRef

Kuderna H (1980) Connection between deviated axis and impaired function after fractures of the forearm. Unfallchirurgie 6(1):7–13PubMedCrossRef

Matthews LS, Kaufer H, Garver DF, Sonstegard DA (1982) The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm. J Bone Joint Surg Am 64(1):14–17PubMed

10.

Roberts JA (1986) Angulation of the radius in children’s fractures. J Bone Joint Surg Br 68(5):751–754PubMed

11.

Tarr RR, Garfinkel AI, Sarmiento A (1984) The effects of angular and rotational deformities of both bones of the forearm. An in vitro study. J Bone Joint Surg Am 66(1):65–70PubMed

12.

Trousdale RT, Linscheid RL (1995) Operative treatment of malunited fractures of the forearm. J Bone Joint Surg Am 77(6):894–902PubMed

13.

Hogstrom H, Nilsson BE, Willner S (1976) Correction with growth following diaphyseal forearm fracture. Acta Orthop Scand 47(3):299–303PubMedCrossRef

14.

Nilsson BE, Obrant K (1977) The range of motion following fracture of the shaft of the forearm in children. Acta Orthop Scand 48(6):600–602PubMedCrossRef

15.

Nenopoulos SP, Beslikas TA, Gigis JP (2009) Long-term follow-up of combined fractures of the proximal radius and ulna during childhood. J Pediatr Orthop B 18(5):252–260PubMedCrossRef

16.

Krukhaug Y, Hove LM (2007) Corrective osteotomy for malunited extra-articular fractures of the distal radius: a follow-up study of 33 patients. Scand J Plast Reconstr Surg Hand Surg 41(6):303–309PubMedCrossRef

17.

Nagy L, Jankauskas L, Dumont CE (2008) Correction of forearm malunion guided by the preoperative complaint. Clin Orthop Relat Res 466(6):1419–1428PubMedCrossRef

18.

Price CT, Knapp DR (2006) Osteotomy for malunited forearm shaft fractures in children. J Pediatr Orthop 26(2):193–196PubMedCrossRef

19.

Graham TJ, Fischer TJ, Hotchkiss RN, Kleinman WB (1998) Disorders of the forearm axis. Hand Clin 14(2):305–316PubMed

20.

Beyer W, Stolzenburg T, Paris S (1995) Functional limitation of the forearm after shaft fracture in childhood. Possible role of the antebrachial interosseous membrane: MRI and ultrasound studies. Unfallchirurgie 21(6):275–284PubMedCrossRef

21.

Kihara H, Palmer AK, Werner FW, Short WH, Fortino MD (1996) The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation. J Hand Surg Am 21(1):40–47PubMedCrossRef

22.

Nakamura T, Yabe Y, Horiuchi Y (1994) A biomechanical analysis of pronation-supination of the forearm using magnetic resonance imaging: dynamic changes of the interosseous membrane of the forearm during pronation-supination. Nippon Seikeigeka Gakkai Zasshi 68(1):14–25PubMed

23.

Nakamura T, Yabe Y, Horiuchi Y, Seki T, Yamazaki N (2000) Normal kinematics of the interosseous membrane during forearm pronation-supination—a three-dimensional MRI study. Hand Surg 5(1):1–10PubMedCrossRef

24.

Price CT, Scott DS, Kurzner ME, Flynn JC (1990) Malunited forearm fractures in children. J Pediatr Orthop 10(6):705–712PubMedCrossRef

25.

Yasutomi T, Nakatsuchi Y, Koike H, Uchiyama S (2002) Mechanism of limitation of pronation/supination of the forearm in geometric models of deformities of the forearm bones. Clin Biomech 17(6):456–463CrossRef

26.

Colaris J, van der Linden M, Selles R, Coene N, Allema JH, Verhaar J (2010) Pronation and supination after forearm fractures in children: reliability of visual estimation and conventional goniometry measurement. Injury 41(6):643–646PubMedCrossRef

27.

Bindra RR, Cole RJ, Yamaguchi K, Evanoff BA, Pilgram TK, Gilula LA et al (1997) Quantification of the radial torsion angle with computerized tomography in cadaver specimens. J Bone Joint Surg Am 79(6):833–837PubMed

28.

Freitas LF, Barbieri CH, Mazzer N, Zatiti SC, Bellucci AD, Nogueira-Barbosa MH (2010) Intraobserver and interobserver reliability of radial torsion angle measurements by a new and alternative method with computed tomography. Clinics 65(11):1093–1097PubMedCrossRef

29.

Dumont CE, Pfirrmann CW, Ziegler D, Nagy L (2006) Assessment of radial and ulnar torsion profiles with cross-sectional magnetic resonance imaging. A study of volunteers. J Bone Joint Surg Am 88(7):1582–1588PubMedCrossRef

30.

Aufauvre B, Garcier JM, Boisgard S, Tanguy A (1996) Measurement of the torsion of the two bones of the forearm: evaluation of tomodensitometric reference points. Bull Assoc Anat 80(248):5–8

Title: Three-dimensional imaging of children with severe limitation of pronation/supination after a both-bone forearm fracture
Authors: Joost W. Colaris
Stanley Oei
Max Reijman
Herma Holscher
Jan Hein Allema
Jan A. N. Verhaar
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2014
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-014-1922-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Three-dimensional imaging of children with severe limitation of pronation/supination after a both-bone forearm fracture

Abstract

Introduction

Patients and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

Level of evidence

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