Casting Versus Flexible Intramedullary Nailing in Displaced Pediatric Forearm Shaft Fractures

NCT ID: NCT04664517

Last Updated: 2024-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-05-01

Study Completion Date

2024-12-31

Brief Summary

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The forearm is the most common fracture location in children, with an increasing incidence. Displaced forearm shaft fractures have traditionally been treated with closed reduction and cast immobilization. Diaphyseal fractures in children have poor remodeling capacity, and malunion can thus cause permanent cosmetic and functional disability. Internal fixation especially with flexible intramedullary nails has gained increasing popularity, without evidence of a better outcome compared to closed reduction and cast immobilization.

Detailed Description

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This is a multicenter, randomized superiority trial comparing closed reduction and cast immobilization to flexible intramedullary nails in 7-12 year old children with \> 10° of angulation and/or \> 10mm of shortening in displaced both bone forearm shaft fractures (AO-pediatric classification: 22D/2.1-5.2). A total of 78 patients with minimum 2 years of expected growth left are randomized in 1:1 ratio to either treatment group. The study has a parallel non-randomized patient preference arm. Both treatments are performed under general anesthesia. In the cast group a long arm cast is applied for 6 weeks. The flexible intramedullary nail group is immobilized in a collar and cuff sling for 4 weeks. Data is collected at baseline and at each follow-up until 1 year.

Primary outcome is 1) PROMIS Pediatric Item Bank v2.0 - Upper Extremity and 2) forearm pronation-supination range of motion at one-year follow-up. Secondary outcomes are Quick DASH, Pediatric pain questionnaire, Cosmetic VAS, wrist range of motion as well as any complications (malunion, delayed union, non-union or deep wound infection, peripheral nerve injury, need for re-intervention during 1-year follow-up) and costs of treatment.

The investigators hypothesize that flexible intramedullary nailing results in a superior outcome.

Conditions

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Both Bone Forearm Fracture AO Classification 22D/2.1-5.2 7-12 Year Old

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

multicenter, randomized superiority trial. Parallell patient choice arm.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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FIN (Flexible intramedullary nail)

Fracture reduction and fixation using flexible intramedullary nails. Nails size is 0.4 times the smallest diameter of the medullary canal of radius or ulna measured in radiographs.

Group Type ACTIVE_COMPARATOR

Flexible intramedullary nail (FIN)

Intervention Type PROCEDURE

Both bone FIN

Long arm cast

Fractures are reduced under general anesthesia within 3 days from injury and a synthetic circular above elbow cast in neutral pro-supination is applied for six weeks.

Group Type ACTIVE_COMPARATOR

Reduction auder general anesthesia and long arm cast

Intervention Type PROCEDURE

Reduction and cast

Patient Choice FIN

Fracture reduction and fixation using flexible intramedullary nails. Nails size is 0.4 times the smallest diameter of the medullary canal of radius or ulna measured in radiographs.

Group Type OTHER

Flexible intramedullary nail (FIN)

Intervention Type PROCEDURE

Both bone FIN

Patient Choice cast

Fractures are reduced under general anesthesia within 3 days from injury and a synthetic circular above elbow cast in neutral pro-supination is applied for six weeks.

Group Type OTHER

Reduction auder general anesthesia and long arm cast

Intervention Type PROCEDURE

Reduction and cast

Interventions

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Flexible intramedullary nail (FIN)

Both bone FIN

Intervention Type PROCEDURE

Reduction auder general anesthesia and long arm cast

Reduction and cast

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* 7 to12 year old children
* Open distal radial physis
* Both bone forearm shaft fractures (AO-pediatric classification: 22D/2.1-5.2)
* More than 10 degrees of angulation
* with or without less than 10mm of shortening

Exclusion Criteria

* Patients with bilateral fractures
* Gustilo-Anderson grade I-III open fracture
* Neurovascular deficit
* Compartment syndrome
* Pathologic fracture
* Patient not able to give a written informed consent
Minimum Eligible Age

7 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Helsinki University Central Hospital

OTHER

Sponsor Role lead

Responsible Party

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Petra Grahn

Hand Surgeon, Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ilkka Helenius, MD

Role: STUDY_DIRECTOR

Helsinki University Central Hospital

Petra Grahn, MD

Role: PRINCIPAL_INVESTIGATOR

Helsinki University Central Hospital

Locations

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HUS New Childrens Hospital

Helsinki, , Finland

Site Status RECRUITING

Kuopio University Hospital

Kuopio, , Finland

Site Status RECRUITING

Oulu University Hospital

Oulu, , Finland

Site Status NOT_YET_RECRUITING

Tampere University Hospital

Tampere, , Finland

Site Status NOT_YET_RECRUITING

Turku University Hospital

Turku, , Finland

Site Status RECRUITING

Countries

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Finland

Central Contacts

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Petra Grahn, MD

Role: CONTACT

+35894711

Facility Contacts

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Petra Grahn, MD

Role: primary

+358 9 4711

Matti Ahonen, MD

Role: backup

+ 358 9 4711

Yrjänä Nietosvaara, MD

Role: primary

Juha-Jaakko Sinikumpu, MD

Role: primary

Anne Salonen, MD

Role: primary

Johanna Syvänen, MD

Role: primary

References

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Grahn P, Sinikumpu JJ, Nietosvaara Y, Syvanen J, Salonen A, Ahonen M, Helenius I. Casting versus flexible intramedullary nailing in displaced forearm shaft fractures in children aged 7-12 years: a study protocol for a randomised controlled trial. BMJ Open. 2021 Aug 20;11(8):e048248. doi: 10.1136/bmjopen-2020-048248.

Reference Type DERIVED
PMID: 34417215 (View on PubMed)

Related Links

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https://bmjopen.bmj.com/

Protocol publication

Other Identifiers

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78/1801/2020

Identifier Type: -

Identifier Source: org_study_id

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