Surgical and Conservative Management are Both Effective for Pediatric Both Bone Forearm Fractures: A Systematic Review and Meta-Analysis.

Abstract

Treatment of both bone forearm fractures (BBFFs) in skeletally immature patients includes both operative and nonoperative strategies. However, there is no literature-supported consensus as to which intervention provides optimal patient outcomes. This systematic review and meta-analysis compares the outcomes of surgical and conservative treatment in the management of BBFFs in skeletally immature patients. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed across Medline, Scopus, PubMed, and CENTRAL from inception to August 2024. Studies reporting clinical outcomes of skeletally immature patients with BBFFs treated with either: 1) surgical, including intramedullary nailing and plating, or 2) nonoperative methods, i.e. casting, were included. Statistical analyses were conducted using RStudio (Posit, Boston, MA, USA). The initial search yielded 1884 studies, of which a total of 24 studies with 1,157 patients (surgical: 807, mean age: 11.40 years; conservative: 350, mean age: 8.59 years) met the inclusion criteria. Functional outcomes showed excellent results in both groups (<i>P</i> = .2701). The overall rate of complications, which included redisplacement, refracture, need for additional interventions, infections, and neuropraxia, was significantly higher in the conservative group (24%) compared to the surgical group (12%), with a risk ratio of 1.91 (95% CI: 1.47, 2.49). Redisplacement was also significantly higher in the conservative group (26%) compared to the surgical group (3%), with a risk ratio of 10.08 (95% CI: 2.52, 40.37). The need for additional interventions was higher in the conservative group (14%) than in the surgical group (5%), with a risk ratio of 2.66 (95% CI: 1.42, 4.99). Time to union was significantly longer in the surgical group (8.26 ± 1.66 weeks) compared to the conservative group (6.50 ± 1.29 weeks) (<i>P</i> < .001). Despite this, union rates were 100% in both groups. Both conservative and surgical management of pediatric BBFFs yielded high union rates and excellent functional outcomes. Surgical treatment demonstrated lower complication and redisplacement rates but was associated with a longer time to union. These findings suggest that surgical treatment may be preferable for reducing redisplacement and the need for additional interventions in older children with reduced remodeling potential.<h4>Key concepts</h4>(1)Both conservative and surgical treatment of pediatric both bone forearm fractures result in excellent functional outcomes and 100% union rates, which supports the effectiveness of both approaches in skeletally immature patients.(2)Surgical management is associated with significantly lower rates of redisplacement (3% vs 26%) as well as lower need for additional interventions (5% vs 14%) compared to conservative treatment, highlighting its benefit in maintaining fracture stability.(3)Although the time to union was longer with surgical treatment (8.26 vs 6.50 weeks), this did not negatively impact final functional outcomes.(4)Age-related remodeling potential remains a key determinant in treatment selection, with conservative treatment more suitable for younger children and surgical treatment preferable in older children with diminished remodeling capacity.<h4>Level of evidence</h4>III.