Published June 2016
Journal of Pediatric Orthopaedics

Forearm fractures of both the radius and ulna can be treated with a less invasive, more conservative approach called rereduction—a procedure that is as effective as surgery but delivers up to 50 percent cost savings.

The approach involves a second re-setting of fractured bones that have lost alignment several days after being initially manipulated into position and placed in a cast. In about 25 percent of cases, fractured bones misalign as they heal, which typically prompts surgical treatment using nails or plates to stabilize them.

Shital Parikh, MD, co-director of the Orthopaedic Sports Center, and Viral Jain, MD, analyzed the outcomes of 31 children treated between 2008-2013 with the rereduction approach. Their findings appear in the June 2016 Journal of Pediatric Orthopaedics.

Re-aligning the bones and applying a second cast produced satisfactory radiographic outcomes in 87 percent of cases. The average cost of treatment was $2,056, compared to $4,589 for surgery.

"The second reduction was able to hold the fracture in place in a very good, very stable position,” Parikh says. “Previously, the conventional wisdom was that if initial reduction in the emergency department failed, it would not hold if we reduced it again. We proved that the bone does hold.”

The cost savings resulted from avoiding an operation to implant stabilization devices, and a second procedure six months later to remove the hardware.