Conservative versus Surgical Treatment of Pediatric Both-Bone Forearm Fractures: A Systematic Review and Meta-Analysis

Abstract

Treatment of both-bone forearm fractures (BBFF) in skeletally immature patients includes surgical and conservative strategies; however, there is no literature-supported consensus on which provides optimal patient outcomes. This systematic review and meta-analysis compares the outcomes of surgical versus conservative treatment in the management of BBFF in skeletally immature patients. A search of Medline, Scopus, PubMed, and CENTRAL databases was performed from inception to August 2024. Studies included reported outcomes for BBFF treated surgically (intramedullary nailing, plating) or conservatively (casting) and were selected per PRISMA guidelines. Statistical analyses were conducted using DataParty, which utilizes Python 3.8.10. A total of 25 studies with 1187 patients (surgical: 837; conservative: 350) were included. Patients in the surgical group had a mean age of 8.59 years, while those treated conservatively averaged 10.92 years. The complication rate was higher in the conservative group (43%, 95% CI [0.33, 0.52]) compared to the surgical group (16%, 95% CI [0.07, 0.27]), with high heterogeneity observed in the surgical group (I² = 93%). The union rate was 100% in the conservative group and 99% in the surgical group, with minimal heterogeneity (I² = 0% and 13%, respectively). Excellent price grading was reported in 83% of cases managed conservatively (95% CI [0.73, 0.91]) and 77% of surgically treated cases (95% CI [0.59, 0.91]), with high heterogeneity (I² = 77% and 91%, respectively). In conclusion, surgical treatment of BBFF may reduce complication rates compared to conservative management. Future high-quality trials are warranted to further clarify management guidelines for pediatric BBFF.