The aims of this study were i) to see if there is an association between poorly applied plasters and redisplacement of paediatric forearm fractures, and ii) to define reliable radiographic measurements to predict redisplacement of these fractures. The two radiographic measurements which were assessed were Cast Index and Padding Index which are a guide to plaster moulding and padding respectively. The sum of these was termed as the Canterbury Index. Case records and radiographs of 142 children who underwent a manipulation for a displaced fracture of forearm were studied. Angulation, translation displacement, Cast index and Padding index were measured on radiographs. Redisplacement was seen in 44 cases (32.3%). The means and 95 % Confidence intervals for cast index and padding index were 0.87 (0.84, 0.90) and 0.42 (0.39, 0.62) in the redisplacement group whereas were 0.71 (0.69, 0.72) and 0.11 (0.09, 0.12) in the group with no redisplacement respectively. Initial displacement, Cast index, Padding index and Canterbury Index were significantly greater in the redisplacement group (p< 0.005). No statistically significant difference was seen for age, fracture location, initial angular deformity and seniority of the surgeon. We suggest that Cast Index > 0.8, Padding Index > 0.3 and Canterbury Index > 1.1 are significant risk factors for redisplacement of conservatively treated paediatric forearm fractures

We aimed to evaluate the relationship of forearm rotation with the magnitude of radial bowing and the localization of maximal radial bowing in children. The purpose of the study was to estimate the future forearm rotation limitation related the with the radial bowing. Forearm fractured 26 children (younger than 15 years, 20 male, 6 female) were evaluated in 2 groups. Operatively treated (n=14) and nonoperatively treated (n=12) groups included diaphysis fracture of both forearm bones. In the early postreductive X-rays, maximal radial bowing (MRB) and the localization of maximal radial bowing (LMRB) were measured. Both groups were re-evaluated after a mean follow up of 25.5 months (range 4–62) clinically by the technique of Price et al. and radiologically by the method of Schemitsch and Richards. The relation of the MRB and LMRB with the forearm rotational movements were evaluated statistically. No meaningful difference could be observed between the MRB and LMRB values of the injured and normal sides statistically (p> 0.05). Operatively treated patient group had closer degrees of MRB when compared with the normal side but there was not any meaningful statistical analysis. The number of patients having forearm rotation was so low that limits of forearm rotation could not be determined by the statistical methods. In the forearm pronation limited cases, it was observed that, when MRB decreases, the ability of pronation decreses and when LMRB increases, the ability of pro-nation also decreases. If radial bowing degrees close to the normal side can be obtained, forearm rotation limitations due to differences of radial bowing can be prevented. The mean values of radial bowing and localization of radial bowing must be measured after forearm fractures of both bones

This study was conducted to investigate the characteristics, complications, radiologic features and clinical course of patients undergoing reduction of forearm fractures in order to better inform patient prognosis and postoperative management. We conducted a retrospective cohort study of 1079 pediatric patients treated for forearm fractures between January 2014 and September 2021 in a 327 bed regional medical center. A preoperative radiological assessment and chart review was performed. Percent fracture displacement, location, orientation, comonution, fracture line visibility and angle of angulation were determined by AP and lateral radiographs. Percent fracture displacement was derived by: (Displacement of Bone Shafts / Diameter) x 100% = %Fracture Displacement. Angle of angulation and percent fracture displacement were calculated by averaging AP and lateral radiograph measurements. 80 cases, averaging 13.5±8.3 years, were identified as having a complete fracture of the radius and/or ulna with 69 receiving closed reduction and 11 receiving fixation via an intramedullary device or percutaneous pinning. Eight patients (10%) experienced complications with four resulting in a refracture and four resulting in significant loss of reduction (LOR) without refracture. Fractures in the proximal ⅔s of the radius were associated with a significant increase in complications compared to fractures in the distal ⅓ of the radius (31.6% vs 3.4%) (P=.000428). Likewise, a higher percent fracture displacement was associated with a decreased risk of complications (28.7% vs 5.9% displacement)(P=0.0403). No elevated risk of complications was found based on fracture orientation, angulation, fracture line visibility, forearm bone(s) fractured, sex, age or arm affected. Our result highlights radius fracture location and percent fracture displacement as markers with prognostic value following forearm fracture. These measurements are simply calculated via pre-reduction radiographs, providing an efficient method of informing risk of complications following forearm fracture

Our study seeks to determine whether characteristics of radiographs taken post-reduction of a forearm fracture can indicate future risk of refracture or loss of reduction. We hypothesize that reducing forearm fractures too precisely may be counterproductive and provide less benefit than reductions left slightly offset prior to cast immobilization. We conducted a retrospective review of 1079 pediatric patients treated for forearm fractures between January 2014 and September 2021 in a 327 bed regional medical center. Percent fracture displacement, location, orientation, comminution, fracture line visibility and angle of angulation were determined by AP and lateral radiographs. Percent fracture displacement was derived by: (Displacement of Bone Shafts / Diameter) x 100% = %Fracture Displacement. Patients treated with closed reduction were reduced from a mean displacement of 29.26±36.18% at an angulation of 22.67±16.57 degrees to 7.88±9.07% displacement and 3.89±6.68 degrees angulation post-reduction. Patients developing complications including a loss of reduction or refracture were found to have post-operative radiographs with a lower percent displacement (0.50±1.12) than those not developing complications (8.65±9.21)(p=0.0580). Post-reduction angulation (p=1.000), average reduction in angulation (p=1.000) and average reduction in displacement percent(p=0.2102) were not significantly associated with development of complications. Percent displacement of radial shafts was seen to be the most important metric to monitor in post-operative radiographs for patients undergoing closed reduction of a forearm fracture. We theorize a slight displacement provides greater surface area for osteoblastic expansion and callus formation leading to a decreased risk of refracture or loss of reduction. While our sample size precludes our ability to measure the ideal amount of post-reduction displacement for optimal healing, our results demonstrate that some degree of shaft displacement is required for optimal healing conditions

Introduction. Deformations of forearm with different degree of expression and functional restrictions of upper limb in children with hereditary multiple exostosis are formed in almost 80% of the cases. The question of indications for the selection and conduct of surgical procedure remains controversial, existing treatment methods and post-operative recovery methods for children need to be improved. Materials and Methods. The long-term outcomes of surgical treatment of 112 patients diagnosed with “Hereditary Multiple Exostosis” (HME) aged from 2 till 17 years old were researched. Evaluation of surgical treatment results was carried out in accordance with complaints, functional condition of the forearm, radiographs (taking into account reference lines and angles). Depending on the variant of deformation, the following surgical operations were performed: resection of bone-cartilage exostoses (in 20.5%); correction of forearm deformation with external fixator (in 79.5). In 14 cases, for a more accurate correction of deformity a hexapod frame was used. Results. Differentiated approach provided “good” anatomical and functional results in 55.6%; “satisfactory” results in 40.2%; “unsatisfactory” results in 4.2%. Postoperative complications in the form of non-union, pseudoarthrosis, delayed consolidation or neurological disorders were in 6.2%. Conclusions. The choice of surgical treatment is determined by the variant and severity of deformation. This approach allows to improve cosmetic and functional condition of forearm and adjacent joints. The use of hexapod allows to increase accuracy of correction of physiological axis of forearm bones

During the medical student’s training in the Anatomy we have studied the arterial constitutions of the forearm in 100 bodies from the Laboratory of the Descriptive Anatomy of the Medical School, University of Athens. On our efforts to classify the complexity of the forearm concerning its blood supply we accepted that we might have some basic groups that can be explained by the embryology. Our results were:. A. “Regular” hematosis of the forearm (with the presence of the radial, the ulnar and the interosseous artery): 81%. All the forearm’s arteries ramify from the brachial artery: 68%. All the forearm’s arteries ramify from the superficial brachial artery: 7%. The radial artery origins from the superficial brachial artery, the ulnar and the interosseous arteries from the brachial artery: 4%. As in 3 with a wide osculation between the brachial and the radial artery in the elbow: 2%. B. Forearm’s superficial arteries: 10%. The superficialulnar artery substitutes the ulnar artery: 4%. Superficial middle artery: 2%. Superficial radial artery in addition to the normal radical artery: 2%. The forearm’s superficial artery is short and ends at the forearm’s proximal part: 2%. C. Presence of the middle artery (embryo remnant): 9%. The middle artery origins from the ulnar artery with the interosseous artery: 3%. The middle artery origins from the ulnar artery far from the common interosseous artery: 2%. The middle artery origins from the common interosseous artery: 2%. The middle artery origins from the radical artery: 2%

Background and Aims:. Forearm fractures are common in the paediatric population and most are treated in a moulded plaster of Paris (POP) cast. It is our concern that many casts applied by our registrars are sub-optimal and that we need to improve our training process. The aim of our study was to review the adequacy of forearm cast application in paediatric patients at our institution and to identify if there is a need for a more formal training program with regard to plaster cast application. Methods:. A retrospective review of control x-rays of forearm fractures treated at our institution was undertaken. X-rays that were reviewed were done as part of the routine treatment protocol. X-ray measurements to assess POP application were the cast index and the gap index. A cast index of > 0.81 and Gap index of > 0.15 were regarded as an indication of poor cast application. Results:. Adequate control X-rays of twenty eight patients with a forearm fracture were available. The average patient age range was 5–12 years. There were thirteen distal metaphyseal fractures, nine diaphyseal fractures and six Salter-Harris type fractures. Of the 28 patients, 20 patients had a poor cast index and 17 patients had poor gap index. In 12 patients both the gap and the cast index were unacceptable. Conclusion:. Our study suggests that paediatric forearm plaster cast application by registrars at our institution is inadequate. This indicates a need for a strategy to improve the training in plaster cast application amongst our registrars

The aim of this study was to document our experience of acute forearm compartment syndrome, and to determine the risk factors for requiring split skin grafting (SSG) and developing complications post fasciotomy. We identified from our trauma database all patients who underwent fasciotomy for an acute forearm compartment syndrome over a 22-year period. Diagnosis was made using clinical signs and/or compartment pressure monitoring. Demographic data, aetiology, management, wound closure, complications and subsequent surgeries were recorded. Outcome measures were the use of SSG and the development of complications following forearm fasciotomy. 90 patients were identified with a mean age of 33 yrs (range, 13–81 yrs) and a significant male predominance (n=82, p<0.001). A fracture of one or both of the forearm bones was seen in 62 (69%) patients, with soft tissue injuries causative in 28 (31%). The median time to fasciotomy was 12hrs (2–72). Delayed wound closure was achieved in 38 (42%) patients, with 52 (58%) undergoing SSG. Risk factors for requiring a SSG were younger age and a crush injury (both p<0.05). Complications occurred in 29 (32%) patients at mean follow-up of 11 (3–60) months. Risk factors for developing complications were a delay in fasciotomy of >6 hrs (p=0.018), with pre-operative motor symptoms approaching significance (p=0.068). Forearm compartment syndrome requiring fasciotomy predominantly affects males and can occur following either a fracture or soft tissue injury. Age is an important predictor of undergoing SSG for wound closure. Complications occur in a third of patients and are associated with an increasing delay in the time to fasciotomy

Aim of Study: Assess clinical outcome and function of planned marginal excision of low grade liposarcoma of the forearm. Material and Methods: Between 1997 and 2005 15 of 27 soft tissue sarcomas of the forearm were liposarcoma. 13 presented in the extensor compartment and 2 flexor compartment at the level of the distal radius. All presented with a painless mass. 5 patients with neurological symptoms. 4 involving the post interosseus nerve and 1 radial nerve. MRI was the diagnostic imaging technique of choice, 2 had biopsies where there was atypical imaging features. Treatment and Results: All treated by planned marginal excision in view of proximity of neurovascular structures. The majority of tumours of the extensor compartment of the forearm were either involving or abutting the post interosseus nerve or neurovascular conduit. All underwent planned marginal excision preserving juxtaposed peripheral nerve. There were no radial, spiral or PIN nerve palsies. One patient presented with PIN palsy had partial resolution of symptoms and function. I wound infection. Conclusion: Low grade lipoma-like liposarcomas have low metastatic potential. In the forearm a wide margin would mean ablation of critical neurological structures and planned marginal excision results in good function and to date no evidence of local recurrence at 2–9 year follow up

The aim was to assess the long-term impact of humeral and forearm rodding on functional ability, grip strength, joint range of motion and angular deformity in children with osteogenesis imperfecta. A retrospective chart review was conducted on 57 children with osteogenesis imperfecta who underwent humeral rodding or forearm rodding at our institution between 1996 and 2013. Functional ability was assessed using the self-care and mobility domains of the Pediatric Evaluation and Disability Inventory (PEDI). Grip strength was measured using a dynamometer and joint range of motion with a goniometer. Deformity was measured on radiographs of the humerus or forearm. Outcomes were assessed pre-operatively and every year post-operatively. Differences between pre-operative and 1-year post-operative outcomes were compared using paired T-tests. In 44 patients with a minimum of 2 years follow-up, outcome measures at 1-year post-surgery were compared to those at the latest clinic visit (mean follow-up = 8.0 years). Humeral and forearm rodding resulted in a significant improvement in PEDI self-care score (mean change =5.75, p=0.028 for the humerus, mean change = 6.77, p=0.0017 for the forearm) and mobility score (mean change =3.59, p=0.008 for the humerus, mean change =7.21, p=0.020 for the forearm) at 1 year post-surgery. Grip strength improved following forearm rodding (mean change = +6.13N, p=0.015) but not humeral rodding. Joint range of movement improved following humeral rodding but not forearm rodding. There was a significant improvement in radiographic angular deformity of the forearm and humerus following surgery (p<0.0001). Over 80% of improvements were maintained in the long-term. Humeral and forearm rodding in children with osteogenesis imperfecta leads to long-term improvement in functional ability and angular deformity

Forearm fractures are a common paediatric injury. This study was aimed to describe the epidemiological of paediatric forearm fractures in the urban population of Glasgow. We reviewed of all the forearm fracture treated by the orthopaedic service in Yorkhill Children's Hospital in 2008. Datum gathered from case notes and radiographs using the prospective orthopaedic database to identify patients with forearm fractures. The age, sex, side and type of fracture, the timing and mechanism of the injury and treatment were documented for the 436 fractures. Census data were used to derive absolute age-specific incidences. Distinction was made between torus and other types of fractures. Torus fractures require no specific orthopaedic treatment and were segregated out. For the remaining 314 fractures, the age and sex distribution, seasonal variation of fractures and treatments for each type of fracture were examined. The incidence of forearm fractures in our population is 411 fractures per 100,000 population per year. An increased number of fractures occurred during the months of May and August. A fall from less than one metre was the commonest mechanism of injury, sporting injuries were the second commonest with football the most common sport associated. This study identifies some features which are in good agreement with studies from elsewhere in Britain, such as incidence and seasonality. However, there are also interesting differences – such as the Glasgow peak incidence for forearm fractures being at age 8, with a marked decline by 12 years. Furthermore, our findings have been extended to consideration of type of intervention, and likelihood of successful treatment

Purpose. Penetrating injuries of the hand and forearm may cause significant morbidity for a patient. Our aim was to evaluate the accuracy of initial examination of forearm lacerations and pre-operative examination and compare both to the actual findings on surgical exploration. We wanted to identify any factors which may influence the accuracy of the initial examination. Existing literature indicates that there are differences between initial and subsequent examination in terms of picking up injuries. Methods. 65 consecutive patients with penetrating injuries to the hand/forearm were studied. The admitting casualty doctor/s completed an admission form indicating their findings on examination. Factors which may have hampered history taking and examination were noted on the form. The same form was filled in prior to surgery by one of the hand registrars after re-examining the patient prior to surgery. A separate surgical form was filled in by the surgeon indicating the actual findings at surgery. Results. Our results show that as many as 40% of injuries are missed on examination initially by casualty officers but only 10% are missed on re-examination post admission. Factors such as alcohol intoxication and distracting injuries seem to play a role in the casualty examination being difficult. Conclusion. Underlying injuries to structures in the forearm and hand are often missed on initial examination of lacerations involving the forearm and hand. Re-examination post admission of the patient is essential to avoid underestimating the extent and time of surgery required to treat the patient. Factors identified as possibly contributing to this are alcohol intoxication, distracting injuries and language problems in the casualty setting. NO DISCLOSURES

The Interosseous Membrane (IOM) of the forearm is made up of ligaments, which are involved in load balancing of the radioulnar joint and the shaft. Motion models of the forearm are necessary for planning orthopedic surgeries, such as osteotomies, which aim at solving limit of the range of motion or instabilities. However, existing models focus on a pure kinematic approach, omitting the physical properties of the ligaments, thus limiting the range of application by missing dynamical effects. We developed a model that takes into account the mechanical properties of the IOM. We simulated the pro-supination by creating an elastic coupling to the desired motion around the standard axis of rotation. We tested our model on a healthy subject, using CT-reconstructed bone models, and literature data for the ligaments. Multiple parameters, including forces of ligaments and positions of landmarks, are output for analysis. The length of the ligaments over pro-supination was in agreement with the literature. Their rest lengths must be recorded in future anatomical studies. The IOM helps in maintaining the contact with cartilage, except in late pronation. Scarring of the central band increases the force generated along the axis of rotation toward the wrist, while scarring of the proximal part does the opposite in pronation. In contrast to kinematic models, the proposed model is helpful to study the effect of physical properties of the IOM, such scarring, on the forearm motion. Future work will be to apply our model to pathological cases, and to compare to clinical observations

Altered distal radioulnar joint contact (DRUJ) mechanics are thought to cause degenerative changes in the joint following injury. Much of the current research examining DRUJ arthrokinematics focuses on the effect of joint malalignment and resultant degenerative changes. Little is known regarding native cartilage contact mechanics in the distal radioulnar joint. Moreover, current techniques used to measure joint contact rely on invasive procedures and are limited to statically loaded positions. The purpose of this study was to examine native distal radioulnar joint contact mechanics during simulated active and passive forearm rotation using a non-invasive imaging approach. Testing was performed using 8 fresh frozen cadaveric specimens (6 men: 2 women, mean age 62 years) with no CT evidence of osteoarthritis. The specimens were thawed and surgically prepared for biomechanical testing by isolating the tendons of relevant muscles involved in forearm rotation. The humerus was then rigidly secured to a wrist simulator allowing for simulated active and passive forearm rotation. Three-dimensional (3D) cartilage surface reconstructions of the distal radius and ulna were created using volumetric data acquired from computed tomography after joint disarticulation. Using optically tracked motion data and 3D surface reconstructions, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. The results of this study indicate that contact area was maximal in the DRUJ at 10 degrees of supination (p=0.002). There was more contact area in supination than pronation for both active (p=0.005) and passive (p=0.027) forearm rotation. There was no statistically significant difference in the size of the DRUJ contact patch when comparing analogous rotation angles for simulated active and passive forearm motion (p=0.55). The contact centroid moved 10.5±2.6 mm volar along the volar-dorsal axis during simulated active supination. Along the proximal-distal axis, the contact centroid moved 5.7±2.4 mm proximal during simulated active supination. Using the technique employed in this study, it was possible to non-invasively examine joint cartilage contact mechanics of the distal radioulnar joint while undergoing simulated, continuous active and passive forearm rotation. Overall, there were higher contact area values in supination compared with pronation, with a peak at 10 degrees of supination. The contact centroid moved volarly and proximally with supination. There was no difference in the measured cartilage contact area when comparing active and passive forearm rotation. This study gives new insight into the changes in contact patterns at the native distal radioulnar joint during simulated forearm rotation, and has implications for increasing our understanding of altered joint contact mechanics in the setting of deformity

Background: Chronic compartment syndrome is well recognised. Patients present with exercise-induced pain, relieved by rest. The condition is caused by increased intracompartmental pressure due to inadequate muscle compartment fascial size. Cases of forearm chronic compartment are sporadic. Previous published case series affecting the upper limb have not used compartment pressure monitoring to aid diagnosis. In our chronic compartment pressure monitoring clinic we confirmed the diagnosis of four cases. Following these a review of the literature showed that there was no definition of normal pre or post-exercise pressure for the upper limb. Aim: This study aimed to establish the normal pre and post-exercise forearm pressures in asymptomatic normal individuals to give a baseline upon which perceived raised pressures could be calculated against. Methods: Ethical approval was obtained from Dorset Research and Ethics Committee. 41 participants underwent compartment pressure measurements of the superficial extensor and flexor forearm compartments before and after five minutes of exercise. A Stryker intracom-partmental pressure monitor was used. Results: Normal ranges for pre-exercise extensor compartment (2–27mmHg, upper CI 18.8–25.2mmHg), post-exercise extensor compartment (2–24mmHg, upper CI 16.8–22.8mmHg), pre-exercise flexor compartment (1–19mmHg, upper CI 13.3–17.4mmHg) and post-exercise flexor compartment (0–19mmHg, upper CI 16–21.4mmHg) pressures were established. No significant difference was found between pressures before and after exercise (extensor pressures; p=0.41, flexor pressures; p=0.21). There was a significant difference between sexes (extensor pressures; p=0.04, flexor pressures; p=0.008). Conclusion: This study has shown a significant difference in normal forearm compartment pressures between sexes. No difference between pre and post-exercise pressure could be established. A normal reference range of forearm compartment pressures to aid diagnosis of chronic compartment syndrome has been determined. This may also prove useful in aiding the diagnosis of acute forearm compartment syndrome

Purpose: Surgical treatment with circular external fixation of forearm deformities and shorthening in patients with congenital and posttraumatic pathologies remains controversial. The purpose of the present study was to determine the reasonable indications for operative treatment and to evaluate long-term results of forearm surgery in these patients. We review the results of correction of deformities and length discrepancies of the forearm using circular external fixator. Methods and Materials: We evaluated the results of distraction lengthening in 25 forearms of 24 patients with forearm shortening and deformity. The mean age at the time of surgery was 18.2 years (range 6 to 55 years). Etiologies were: congenital radioulnar synostosis and deformity of the forearm (2), multiple hereditary exostoses (3), distal radial physeal arrest (2), Madelung’s deformity (5), congenital shortening of both bones (1), radial clubhand with Bayne type I deficiency (2), pseudoartrosis (6), malunion correction (3), Forearm Elongation After Hand Replantation (1). The ulna was involved in 14 cases and the radius in 11. The lengthening technique consisted in a subperiosteal osteotomy and progressive distraction after 5 days of waiting period. In majority of cases the deformity and shortening of ulna and radius were different, for this reason we use separate system for lengthening and correction for each bone. That permits to correct wrist deformity and restore normal relationships in the distal radioulnal syndesmosis. Results: All 25 forearms were reviewed at a mean 28,6 months. Mean lengthening was 31.2 mm (range 10 – 68 mm). One patient that in the pass was treated with monolateral fixator, had other two subsequent lengthening and obtains normal length of forearm. One patient has radial nerve palsy after 21 days of distraction. Reducible claw fingers completely regressed after interruption of the lengthening were observed in 4 cases. There were 2 cases with an axial deviation at the end of lengthening and 2 cases of late healing resolving without a secondary bone graft. The healing index was 49.8 days per cm gained length. Conclusion: Lengthening of the forearm was found to improve upper extremity function and appearance of the arm with satisfaction of all patients

Infection and re-fracture are well-described complications following open paediatric forearm fractures. The purpose of this paper is to determine if patient, injury, and treatment characteristics can be used to predict the occurrence of these complications following the surgical management of paediatric open forearm fractures. This is an IRB-approved retrospective review at a single-institution paediatric level 1 trauma centrefrom 2007–2013 of all open forearm fractures. Medical records were reviewed to determine the type of open fracture, time to administration of initial antibiotics, time from injury to surgery, type of fixation, length of immobilisation, and complications. Radiographs were studied to document fracture characteristics. 262 patients with an average age of 9.7 years were reviewed. There were 219 Gustillo-Anderson Type 1 open fractures, 39 Type 2 fractures, and 4 Type 3 fractures. There were 9 infections (3.4%) and 6 re-fractures (2.3%). Twenty-eight (10.7%) patients returned to the operating room for additional treatment; 21 of which were for removal of implants. Contaminated wounds, as documented within the medical record, had a greater chance of infection (21% vs 2.2%, p=0.002). No difference in infection rate was seen with regard to timing of antibiotics (p=0.87), timing to formal debridement (p=0.20), Type 1 versus Type 2 or 3 open fractures (3.4% vs 5.0%, p=0.64), 24 hours vs. 48 hours of post-operative IV antibiotics (5.2% vs 3.5%, p=0.53), or when comparing diaphyseal, distal, and Monteggia fracture patterns (3.6 vs 2.9% vs 5.9%, p=0.81). There was no difference in infection rate when comparing buried or exposed intramedullary implants (3.5% vs 4.2%, p>0.99). Rate of re-fracture was not increased based on type of open wound (p>0.99) or fracture type (0.4973), although 5 of the 6 re-fractures were in diaphyseal injuries. In this series of open paediatric both bone forearm fractures, initial wound contamination was a significant risk factor for subsequent infection. The rate of infection did not vary with timing of antibiotics or surgery, type of open fracture, or length of post-operative antibiotics. A trend to higher re-fracture rates in diaphyseal injuries was noted. Surgeons should consider planned repeat irrigation and debridement for open forearm fractures with obviously contaminated wounds to reduce the subsequent infection risk

Purpose of the study: Unlike thoracic and abdominal stab wounds, little has been reported about blade wounds to the forearm. We report a serie of machete wounds to the forearm treated in the Caribbean island Martinique, between 1997 and 2004. Material and methods: This study included 14 open fractures of the forearm caused by machete wounds. This retrospective analysis was based on the patient files. We studied the mechanism of the fracture, the type and level of the fractures, the associated lesions, the type of treatment given, and complications observed. Results: Mean follow-up was seven months. Among the 14 patients studied, 14 presented an ulnar fracture, and five a radial fracture. Five patients suffered a complete amputation of the hand. Ten patients (71%) also had associated tendon injuries, all on the ulnar side. Three associated vascular injuries were noted (21%), two on the ulnar side. There were four nerve lesions (29%) involving the ulnar nerve alone (n=2),the ulnar and medial nerves (n=1) or all of the nerve trunks (n=1). The fractures involved the distal third of the forearm in nine patients (64%) and were comminutive for ten (71%). A complete fracture was noted in twelve patients (86%) with a partial fracture in two. Osteosynthesis was performed in all cases. There were nine complications: early infection (n=2, due to late referral), stiff joints (n=6, 43% including tendon retraction in five), nonunion (n=2, one repeated case) and one late healing at one year. Motor and sensorial sequelae were observed at last follow-up in all patients with an initial nervous lesion. Discussion: The mean follow-up in our patients was short because of the specific context (homelessness, drug addiction). Most of our patients refused medical follow-up. The strong predominance of bony or soft tissue injuries observed on the ulnar side of the forearm corresponds to the mechanism of defense used by the victims. Despite the fact that the wounds were soiled and that the patients failed to comply with medical advice, the rate of early and secondary infection was low. Stiff joints due to tendon retractions and motor deficits were however frequent and compromised the functional outcome. Conclusion: Fractures of the forearm by machete wounds generally occur in a typical situation of self defense. The characteristic injury to the ulnar side of the forearm results from this mechanism. Tendon and nervous complications are common and cause invalidating sequelae. Secondary infection is exceptional. Prolonged regular follow-up could probably improve the functional outcome of these particular injuries

Forearm deformity is common in Hereditary Multiple Exostoses, for which multiple surgical treatments exist. Acute ulnar lengthening has been described in the literature, though in small numbers and not independent of adjunctive procedures. We hypothesise that acute ulnar lengthening as a primary procedure is safe and effective in correcting forearm deformity. Seventeen ulnas in 13 patients had acute ulnar lengthening for HME associated forearm deformity, over an eight-year period. Radiographic parameters were assessed and compared preoperatively and postoperatively. Mean follow-up was 27 months. Complications and revisions were noted. The mean pre-operative ulnar variance, 12.4mm (range 6.1 – 16.5), was significantly reduced post-operatively to a mean 4.6mm (p=<0.00001). A significant acute difference was achieved in carpal slip, (mean change of −2.2mm, p=0.02) but no significant change was seen with regard to radial bowing (p=0.98) or radial articular angle (p=0.74). There were three episodes of recurrence requiring revision. There were no major complications. Significant radiographic improvements in forearm and wrist alignment were seen with acute ulnar lengthening. Complications were infrequent. Recurrence rates in the skeletally immature patients are comparable to that reported with gradual lengthening techniques. Acute ulnar lengthening for forearm deformity associated with HME, has been demonstrated to be a safe, reproducible and effective surgical procedure

This study retrospectively reviews all forearm lengthenings carried out by the author in order to assess results and complications and determine the efficacy of this treatment in children with various pathologies. The records of all patients who had undergone a forearm lengthening between 1995 and 2009 were reviewed. 23 forearm lengthenings in 20 patients were identified but in one case there was insufficient information for the study. The study is therefore based on 22 lengthenings. The patients were divided into two groups, Group A in whom the purpose of treatment was to restore the length relationship between the radius and ulna and Group B in whom the purpose was to gain forearm length. In Group A patients the aim was to protect the radial head against dislocation by lengthening the ulna (with if necessary a corrective radial osteotomy) or to protect the wrist from subluxation by a radial lengthening. In Group B patients the aim was to improve function and cosmesis. The average age of the patients at time of surgery was 9.78 years, average follow up was 26 months post frame removal. There were 11 patients in Group A with an average radio ulnar discrepancy of 2.34 cms and 11 patients in Group B. In Group A patients the average length achieved was 2.69 cms i.e. overcorrection and in Group B the average lengthening was 3.84 cms. In Group A patients lengthening was only partially successful at preventing subluxation or dislocation of the radial head. Common complications were pin site infection and poor regenerate formation. Forearm lengthening by distraction osteogenesis is a worthwhile procedure in paediatric patients with improved cosmesis and function particularly in Group B patients