Growth behavior after fractures of the distal forearm. Reasons for the high rate of overtreatment

The distal forearm fracture is the most common injury (40 %) in pediatric traumatology. The treatment of distal forearm fractures in the growth phase contains two contrasting phenomena which are incompatible with the patient's interests and are discussed in this article. A selective literature search was carried out and selected cases are discussed. On the one hand there is a unique property of the juvenile skeleton with an enormous potential for spontaneous correction enabling conservative treatment for the majority of fractures. This generally leads to healing without functional or cosmetic defects, even in cases of some minor residual angulations. In contrast, high rates of overtreatment are observed, such as unnecessary or repetitive reductions and operative interventions, which are not only the result of ignorance of the growth prognosis and of correct conservative techniques but also of economic factors as a consequence of medical economization as well as positive experiences gained in adults but which cannot be transferred to children. The management of distal forearm fractures should be reserved for unstable fracture types especially in adolescent patients with limited age-dependent potential for spontaneous correction. Angulated fractures should be treated using cast wedging in order to reduce angulation to a reasonable extent. The most frequently occurring stable torus fractures require immobilization only for analgesic reasons. Intolerable angulations as well as completely dislocated fractures are treated by closed reduction and stabilized with a Kirschner wire osteosynthesis depending on age. Treatment of distal forearm fractures should be appropriate for children as well as highly efficient, by using a minimal amount of effort. Current forms of overtreatment have to be avoided because of moral and in particular economic reasons.