The modified Sauvegrain method guides the treatment of forearm fractures in adolescents
Background: Forearm fractures are the most common paediatric fractures. While successful management in the preadolescent is often conservative, outcomes in adolescents have greatly improved with intramedullary Titanium Elastic Nail System (TENS) and rigid plate fixation. However, there have been no...
| Үндсэн зохиолчид: | , , , , , , |
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| Формат: | Өгүүллэг |
| Хэл сонгох: | English |
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Elsevier
2024-06-01
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| Цуврал: | Journal of Orthopaedic Reports |
| Нөхцлүүд: | |
| Онлайн хандалт: | http://www.sciencedirect.com/science/article/pii/S2773157X23001327 |
| _version_ | 1827224374809198592 |
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| author | Chin Chuen Tan Neeraj Mishra Tessa Wen Xi Tan Ee Ming Chew John Carson Allen Arjandas Mahadev Kenneth Pak Leung Wong |
| author_facet | Chin Chuen Tan Neeraj Mishra Tessa Wen Xi Tan Ee Ming Chew John Carson Allen Arjandas Mahadev Kenneth Pak Leung Wong |
| author_sort | Chin Chuen Tan |
| collection | DOAJ |
| description | Background: Forearm fractures are the most common paediatric fractures. While successful management in the preadolescent is often conservative, outcomes in adolescents have greatly improved with intramedullary Titanium Elastic Nail System (TENS) and rigid plate fixation. However, there have been no objective criteria for determining when TENS may be used in adolescents. This study aimed to compare the modified method of Sauvegrain et al. (2005) for skeletal age scoring against chronological age to predict treatment outcomes in adolescents with a forearm fracture treated by TENS and subsequently determine the skeletal age limits of TENS in adolescents. Patients and methods: This was a single-centre retrospective study of adolescents aged 10–16 years with an isolated, complete diaphyseal forearm fracture managed surgically from January 2014 to 2018. The modified Sauvegrain method provided skeletal age scoring via elbow radiographs. Functional outcomes were classified into good and poor groups by considering the treatment complication, range of motion and functional ability at the final review one year after intervention. Results: There were 128 TENS patients, comprising 15 females and 113 males. On average, males displayed older skeletal age than chronological age with a mean (SD) difference of 1.29 (1.03) years (p < 0.001). The modified Sauvegrain method score was the sole independent predictor of poor treatment outcome in males (AUC 0.71, 95 % CI 0.59–0.83). The Youden J-index identified a modified Sauvegrain method score of ≥26 as statistically predictive of high risk of a poor treatment outcome in TENS-treated male adolescents. Conclusion: The correlation of chronological age to skeletal suitability for TENS treatment is unreliable in adolescents. The modified Sauvegrain method helps determine the skeletal age and should be part of the decision-making in employing TENS. At modified Sauvegrain method score ≥26, the decision for using TENS in male adolescents as treatment should be re-evaluated. Level of evidence: Level III therapeutic study. |
| first_indexed | 2024-03-09T09:16:12Z |
| format | Article |
| id | doaj.art-d6ff2de645ef4476830d9443de9d1f5f |
| institution | Directory Open Access Journal |
| issn | 2773-157X |
| language | English |
| last_indexed | 2025-03-21T17:09:16Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj.art-d6ff2de645ef4476830d9443de9d1f5f2024-06-14T05:47:10ZengElsevierJournal of Orthopaedic Reports2773-157X2024-06-0132100260The modified Sauvegrain method guides the treatment of forearm fractures in adolescentsChin Chuen Tan0Neeraj Mishra1Tessa Wen Xi Tan2Ee Ming Chew3John Carson Allen4Arjandas Mahadev5Kenneth Pak Leung Wong6Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore; Corresponding author. Department of Orthopaedics Surgery, KK Women's and Children's Hospital 100 Bukit Timah Road, Singapore, 229899Department of Orthopaedic Surgery, KK Women's and Children's Hospital, SingaporeDepartment of Orthopaedic Surgery, KK Women's and Children's Hospital, SingaporeDepartment of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore; Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore, SingaporeCentre for Quantitative Medicine, Duke-NUS Medical School, SingaporeDepartment of Orthopaedic Surgery, KK Women's and Children's Hospital, SingaporeDepartment of Orthopaedic Surgery, KK Women's and Children's Hospital, SingaporeBackground: Forearm fractures are the most common paediatric fractures. While successful management in the preadolescent is often conservative, outcomes in adolescents have greatly improved with intramedullary Titanium Elastic Nail System (TENS) and rigid plate fixation. However, there have been no objective criteria for determining when TENS may be used in adolescents. This study aimed to compare the modified method of Sauvegrain et al. (2005) for skeletal age scoring against chronological age to predict treatment outcomes in adolescents with a forearm fracture treated by TENS and subsequently determine the skeletal age limits of TENS in adolescents. Patients and methods: This was a single-centre retrospective study of adolescents aged 10–16 years with an isolated, complete diaphyseal forearm fracture managed surgically from January 2014 to 2018. The modified Sauvegrain method provided skeletal age scoring via elbow radiographs. Functional outcomes were classified into good and poor groups by considering the treatment complication, range of motion and functional ability at the final review one year after intervention. Results: There were 128 TENS patients, comprising 15 females and 113 males. On average, males displayed older skeletal age than chronological age with a mean (SD) difference of 1.29 (1.03) years (p < 0.001). The modified Sauvegrain method score was the sole independent predictor of poor treatment outcome in males (AUC 0.71, 95 % CI 0.59–0.83). The Youden J-index identified a modified Sauvegrain method score of ≥26 as statistically predictive of high risk of a poor treatment outcome in TENS-treated male adolescents. Conclusion: The correlation of chronological age to skeletal suitability for TENS treatment is unreliable in adolescents. The modified Sauvegrain method helps determine the skeletal age and should be part of the decision-making in employing TENS. At modified Sauvegrain method score ≥26, the decision for using TENS in male adolescents as treatment should be re-evaluated. Level of evidence: Level III therapeutic study.http://www.sciencedirect.com/science/article/pii/S2773157X23001327SauvegrainElastic nailingExtremityForearm fracturePlating |
| spellingShingle | Chin Chuen Tan Neeraj Mishra Tessa Wen Xi Tan Ee Ming Chew John Carson Allen Arjandas Mahadev Kenneth Pak Leung Wong The modified Sauvegrain method guides the treatment of forearm fractures in adolescents Journal of Orthopaedic Reports Sauvegrain Elastic nailing Extremity Forearm fracture Plating |
| title | The modified Sauvegrain method guides the treatment of forearm fractures in adolescents |
| title_full | The modified Sauvegrain method guides the treatment of forearm fractures in adolescents |
| title_fullStr | The modified Sauvegrain method guides the treatment of forearm fractures in adolescents |
| title_full_unstemmed | The modified Sauvegrain method guides the treatment of forearm fractures in adolescents |
| title_short | The modified Sauvegrain method guides the treatment of forearm fractures in adolescents |
| title_sort | modified sauvegrain method guides the treatment of forearm fractures in adolescents |
| topic | Sauvegrain Elastic nailing Extremity Forearm fracture Plating |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X23001327 |
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