Background: The aim of this study was to assess the predictive factors of delayed union in pediatric forearm fractures. Few previous reports have approached this complication, but contrary to these studies we excluded cases with known pathogenic factors and included in the sample cases treated with conservative methods.
Methods: This is a case-control study of all pediatric shaft forearm fractures presenting delayed union in a minimum follow-up period of 12 months, from 2003 through 2009, in a hospital covering a health area. Exclusion criteria were fracture dislocations, infection, suboptimal osteosynthesis, greenstick, open, pathologic, and associated radial head fractures. Statistical assessment included bivariate and multivariate linear regression analysis.
Results: Four hundred and forty-one complete, both-bone forearm fractures were treated during the study period: 14 of them (3.2%) were identified as suffering delayed union; and 63 controls fulfilling inclusion criteria were randomly selected. Bivariate analysis showed significant differences between "union delay" and "control" groups in age, need of surgical treatment, open versus closed reduction, and mean time to hardware removal. However, open reduction of the fracture, more frequent in the "union delay" group, was the only variable that remained associated with time to consolidation in the multivariate analysis.
Conclusions: The strongest predictor of union delay in pediatric forearm fractures is open reduction. Based on our results, we recommend to avoid when possible the open reduction of the fracture in patients undergoing surgery and to use instead closed reduction and internal fixation.
Level of evidence: A case-control study. Therapeutic level III.