Long-term follow-up of combined fractures of the proximal radius and ulna during childhood.

Forty-five children with combined fractures of the proximal end of the radius and ulna were treated in our orthopedic department over a period of 16 years (1984-1999). The age of the patients ranged from 5 to 12 years (mean 8 years) with a peak of 7-8 years. The mechanism of injury was a fall on the outstretched hand with the elbow extended and with a valgus force being applied to the elbow. In 35 patients, closed reduction or immobilization in plaster, or both, were performed. In the other 10 patients, a surgical treatment was followed either for fractures of the radius (4) or for both the radius and ulna (6). The follow-up period ranged from 4 to 20 years (mean 12 years 3 months). The functional results were satisfactory in most cases despite the poor radiological appearance of some of them. In three patients we found a notable restriction, mainly in forearm pronation-supination and less in elbow flexion-extension, because of upper radioulnar joint synostosis. Poor results related with initial damages at the time of injury and the age of the patient (> 10 years) rather than with the way of treatment. Valgus deformity, restriction in flexion-extension, and pronation-supination were related with the extent of the initial injury but not related with the way of treatment. Overgrowth of the radial head, which had minor impact mainly on the pronation-supination, was found in the majority of cases that underwent surgical treatment. Minor residual abnormalities of the radius, ulna, or both were present without having marked functional influence.