{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:04:58Z","timestamp":1788350698779,"version":"build-2803163510"},"reference-count":43,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,3]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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 immobilisation. Diaphyseal fractures in children have poor remodelling capacity. Malunion can cause permanent cosmetic and functional disability. Internal fixation with flexible intramedullary nails has gained increasing popularity, without evidence of a better outcome compared with closed reduction and cast immobilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method and analysis<\/jats:title>\n                    <jats:p>This is a multicentre, randomised superiority trial comparing closed reduction and cast immobilisation to flexible intramedullary nails in children aged 7\u201312\u2009years with &gt;10\u00b0 of angulation and\/or &gt;10\u2009mm of shortening in displaced both bone forearm shaft fractures (AO-paediatric classification: 22D\/2.1\u20135.2). A total of 78 patients with minimum 2\u2009years of expected growth left are randomised in 1:1 ratio to either treatment group. The study has a parallel non-randomised patient preference arm. Both treatments are performed under general anaesthesia. In the cast group a long arm cast is applied for 6\u2009weeks. The flexible intramedullary nail group is immobilised in a collar and cuff sling for 4\u2009weeks. Data are collected at baseline and at each follow-up until 1\u2009year.<\/jats:p>\n                    <jats:p>Primary outcome is (1) PROMIS paediatric upper extremity and (2) forearm pronation-supination range of motion at 1-year follow-up. Secondary outcomes are Quick DASH, Paediatric Pain Questionnaire, Cosmetic Visual Analogue Scale, wrist and elbow range of motion as well as any complications and costs of treatment.<\/jats:p>\n                    <jats:p>We hypothesise that flexible intramedullary nailing results in a superior outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>We have received ethical board approval (number: 78\/1801\/2020) and permissions to conduct the study from all five participating university hospitals. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\" xlink:href=\"NCT04664517\">NCT04664517<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048248","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T13:07:03Z","timestamp":1629464823000},"page":"e048248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Casting versus flexible intramedullary nailing in displaced forearm shaft fractures in children aged 7\u201312 years: a study protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct04664517","registry":"10.18810\/clinical-trials-gov","type":"preResults"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-8270","authenticated-orcid":false,"given":"Petra","family":"Grahn","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, Helsinki Children\u2019s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juha-Jaakko","family":"Sinikumpu","sequence":"additional","affiliation":[{"name":"Department of Children and Adolescents, PEDEGO unit, University of Oulu and Oulu University Hospital, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yrj\u00e4n\u00e4","family":"Nietosvaara","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, Helsinki Children\u2019s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"},{"name":"Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Syv\u00e4nen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery, Turku University Hospital, Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Salonen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Ahonen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, Helsinki Children\u2019s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilkka","family":"Helenius","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2025121511271529000_11.8.e048248.1","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0000000000000162"},{"key":"2025121511271529000_11.8.e048248.2","first-page":"RC12","article-title":"Evaluation of clinical outcomes of management of paediatric bone forearm fractures using titanium elastic nailing system: a prospective study of 50 cases","volume":"10","author":"Kapila","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"2025121511271529000_11.8.e048248.3","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.155"},{"key":"2025121511271529000_11.8.e048248.4","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2106\/00004623-198466010-00010","article-title":"The effects of angular and rotational deformities of both bones of the forearm. 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