gms | German Medical Science

Objectives: We aimed to evaluate the health-related quality of life (HRQoL) in children with fractures of the distal radius or forearm and to assess if HRQoL was associated with fracture classification, fixation method, secondary displacement, and revision surgery.

Methods: We were able to follow-up on 432 patients (185 girls, 247 boys) who sustained a fracture of the distal radius or forearm from January to June 2007, January to June 2014, and November 2016 to October 2017. Patients filled in questionnaires including the Quick-DASH (Disability of Arm, Shoulder, and Hand; primary-outcome), and the Peds-QL (Pediatric Quality of Life Inventory).

Results: The radius was fractured in 429 cases and the ulna in 175 cases. The most frequent injury of the radius was a buckle fracture (222 children, 51 percent, mean age 8.5 years), followed by a complete fracture (93 children, 22 percent, 9.5 years), Salter-Harris type 2 fracture (62 children, 14 percent, 11.4 years), greenstick fracture (42 children, 10 percent, 9.3 years), Salter-Harris type 1 fracture (5 children, 1%, 12.6 years), and other less frequent injuries.

The most common treatment was a closed reduction and the application of a above elbow cast in 138 cases (32 percent), followed by a cast without prior reduction (129 children, 30 percent), splint (119 children, 28 percent), and closed reduction with K-wire fixation and above elbow cast (39 cases, 9 percent). Definite treatment was performed initially in 95.8 percent of children, a modification (new cast or cast wedging) was performed in 7 cases (1.6 percent), and revision surgery was performed in 11 cases (2.5 percent). There were no open reductions.

After a mean follow-up of 4.2 years, patients with a buckle fracture had a mean Quick-DASH of 3.3, at a scale of 0-100, with lower values representing better HRQoL (complete fracture: 1.5; greenstick: 1.5; Salter-Harris type 1: 0.9; Salter-Harris type 2: 4.1; others: 0.9). The mean function score of the PedsQL ranged from 93.0 for SH-2 fractures to 97.9 for complete fractures, at a scale of 0-100, with higher values representing better HRQoL.

Conclusions: In this cohort of 432 patients with fractures of the distal forearm, there was equally good mean mid- and long-term HRQoL when assessed by the Quick-DASH and the PedsQL.