Introduction Forearm fractures are common among children. Unlike most pediatric fractures, there is a risk of unsatisfactory results in forearm shaft fractures. The healing of a tubular bone is most unlikely in the diaphysis far away from the metaphyseal zones. The treatment of forearm shaft fractures is evolving. The purpose of the study was to analyze the pattern of forearm shaft fractures and their treatment in a population of children in recent years. Materials and Methods All the children (from 0 to 16 years) with a both-bone forearm shaft fracture (AO-segment 22-D) during the years 1997 to 2009 in a catchment area of about 86,000 children were included in this population-based study. There were 291 fractures in all. The age-related annual incidences, background factors, seasonal variation, injury types, treatment, reoperations, and short-term outcome were determined. Results The incidence of all forearm shaft fractures increased threefold in 1997 to 2009 (p < 0.001). Boys predominated (70%) over the girls (p < 0.001). The mean age of the patients was 8.7 years (SD, +/− 3.8) among both genders. The fractures were most common in August and most uncommon in December (p < 0.001). A fall in the playground was the most common type of injury (34%). Ninety-two percent of all patients (N = 269) were treated in the operating room and 44% (N = 119) were invasively stabilized. The incidence of invasive surgery held stable. However, elastic stable intramedullary nailing (ESIN) increased from 10% in 1998–2000 to 30% in 2007–2009 (p = 0.043). There were 77 reoperations (26%); reoperation rate was 5% (6/119) and 41% (N = 71/172) in the invasive and non-invasive treatment groups, respectively. Twenty-three percent of the patients referred did not have better than “good” short-term results. The “excellent” short-term outcome was increasing (p = 0.031). Conclusions We found two mega-trends in pediatric forearm shaft fractures in the period from 1997 to 2009: First, the number of fractures was increasing significantly. Second, the forearm shaft fractures were increasingly treated by an invasive intramedullary method. We also found a significant seasonal variation, but the reason for it is not clear. The findings are based on valuable population-based data and the results are certain. Pediatric trauma centres should prepare themselves for on-going changes in forearm shaft fractures.

Background and purpose — Supracondylar humerus fractures are the most common type of elbow fracture in children. A small proportion of them are flexion-type fractures. We analyzed their current incidence, injury history, clinical and radiographic findings, treatment, and outcomes. Patients and methods — We performed a population-based study, including all children <16 years of age. Radiographs were re-analyzed to include only flexion-type supracondylar fractures. Medical records were reviewed and outcomes were evaluated at a mean of 9 years after the injury. In addition, we performed a systematic literature review of all papers published on the topic since 1990 and compared the results with the findings of the current study. Results — During the study period, the rate of flexion-type fractures was 1.2% (7 out of 606 supracondylar humeral fractures). The mean annual incidence was 0.8 per 105. 4 fractures were multidirectionally unstable, according to the Gartland-Wilkins classification. All but 1 were operatively treated. Reduced range of motion, changed carrying angle, and ulnar nerve irritation were the most frequent short-term complications. Finally, in the long-term follow-up, mean carrying angle was 50% more in injured elbows (21°) than in uninjured elbows (14°). 4 patients of the 7 achieved a satisfactory long-term outcome according to Flynn’s criteria. Interpretation — Supracondylar humeral flexion-type fractures are rare. They are usually severe injuries, often resulting in short-term and long-term complications regardless of the original surgical fixation used.

Background and Aims: Distal forearm is the most common fracture location in the growing skeleton. The aim of this article is to describe the current practice of these fractures. Materials and Methods: Case series accompanied by experts’ opinion. Results and Conclusion: Most of these injuries are benign incomplete distal metaphyseal torus fractures best treated with a dorsal below elbow splint for 2–3 weeks with no follow-up. Completely displaced metaphyseal fractures in prepubertal children can be either immobilized in bayonet position after axial alignment or fixed with K-wires after reduction. Complete fractures of distal metaphysis in adolescents should heal in near anatomic alignment because remodeling is uncertain. We advocate reduction of most greenstick and complete fractures at the distal metaphyseal diaphyseal junction and radiographic follow-up to monitor fracture alignment. Physeal fractures in adolescents and intra-articular fractures in children of all ages should be anatomically reduced. We perform most of our osteosyntheses with K-wires.

The elbow is the joint that most usually dislocates in children. In contrast to the widely known recent increase in the incidence of upper-extremity fractures and their operative treatment in children, potential trends in elbow dislocation are not clear. In this study we aimed to clarify the recent epidemiology of childhood elbow dislocation, in particular the potential change in incidence and treatment. A population-based study was performed to evaluate the annual incidence and the characteristics of injury, patients and treatment. All children < 16 years of age with an elbow dislocation in 1996–2014 in the Oulu University Hospital District, Finland, were included. Elbow dislocations with and without an associated fracture were included. The mean number of children in the population at risk was 85,600, according Statistics Finland. There were 104 patients with a mean age of 11.3 years (SD 2.6). The annual incidence was 6.4 (mean) per 100,000 children in 1996–2014 and no changing trend in incidence during the study period was found. Trampoline jumping was the most usual reason for the dislocations (N = 15, 14.4%). The majority (N = 73/104, 70.2%) were treated non-operatively by reduction and casting. There was no change in surgical treatment during the study time. In contrast to increasing incidence of upper-extremity fractures in children, there has not been a change in the incidence of elbow dislocation in children. There was no change in surgical treatment in 1996–2014.