Grip on recovery after paediatric forearm fractures

Paediatric forearm fractures often do not need to be aligned perfectly, since growing bones can still remodel. Whilst scarce studies advocate less invasive treatments, surgical intervention is becoming an upward trend. This development is worry some, considering the incidence is simultaneously increasing. Functional outcome is rarely examined prospectively, and there is no consensus regarding outcome measures. This thesis focuses on outcome measures of functional recovery. It provides interpersonal and intrapersonal reference values of grip strength. Intrapersonal data is easier to obtain and has a higher accuracy. Compared to other strength measurements, namely key grip and three-jaw chuck, grip strength is more sensitive to change. The extent as well as the duration of strength loss is more prominent the more invasive the treatment underwent. Grip strength is associated with fracture angulation whereas range of motion is not. Loss of mobility of elbow, forearm and wrist can be considered mild with an overall average below 20° for reduced and below 10° for non-reduced fractures 6 weeks post-injury. Measurements of pronation and palmar flexion are significantly impaired up to 3 months post-injury. Similarly to strength, an inverse relation was seen between extent of impairment and invasiveness of treatment. The recovery of pain, reduced sensitivity and hypertrichosis warrants further investigation. Although a trend was observed in relation to treatment invasiveness, the operative group was too small. Future research should focus on the consequences on functional recovery when moving the (arbitrary) lines between successive treatments in favor of the least invasive one.

Dissertation: http://hdl.handle.net/11370/e6ca333a-5e00-49ed-93c7-596ead59f384