Trends in the management of type I and type II open forearm fractures in children

Open forearm fractures (FFs) are common injuries in pediatric patients with variable management, including operative and nonoperative debridement. In this study, we aim to assess trends in management and determine differences in infection rates and costs between operative and nonoperative management for type I and II open both-bone forearm fractures in pediatric patients. This is a retrospective cohort study utilizing the Pediatric Health Information System database. Patients were included if they were aged 16 or younger and had open forearm fractures between 2018 and 2022. Descriptive statistics, χ2 tests, t-tests, linear regression, and logistic regression were used to assess associations between operative and nonoperative management, infection rates, and costs. A total of 3279 patients were included in this study. Approximately 73% of patients were treated with an operative irrigation and debridement (I&D), and 27% of patients were treated nonoperatively. There was no significant trend in management over the study period (P = 0.91). Non-White patients and younger patients were more likely to be treated nonoperatively (P < 0.01). The rate of infection was 2.2% and increased over time (P = 0.03). There was no difference in infection between operative and nonoperative I&D (odds ratio: 1.10, 95% confidence interval: 0.63-1.94, P = 0.74). However, operative management was significantly more expensive ($13 132 vs. $2930; P < 0.01). There has been no significant change in the management of types I and II open forearm fractures over the past 5 years. While there is no significant difference in the infection rate between patients treated operatively and nonoperatively, operative management is significantly more expensive. LEVEL OF EVIDENCE: Level III.