Diaphyseal forearm fractures are common traumatic injuries among children, accounting for 5.4% of all pediatric fractures [1]. Historically, although closed reduction and casting have been considered the standard treatment due to the capacity for vigorous remodeling that pediatric patients with displaced forearm diaphyseal fractures have (especially in patients younger than 10 years old), many reports indicate that operative management to prevent re-displacement in these fractures has gradually increased from the 2000s to the middle of the 2010s [[2], [3], [4], [5]].

Looking back on the 2010s, two key trends occurred. One was the progressive discussion regarding surgical procedures, and the other was the development of ultrasound technology to improve the accuracy of regional anesthesia delivery. Although intramedullary nailing (IMN) has often been performed on relatively young children, there was much debate in the 2010s regarding which surgical procedure to choose, IMN or plate fixation, especially in adolescents [[6], [7], [8], [9]]. A recent systematic review in 2020 reported no significant differences in treatment outcomes and complications between IMN and plate fixation. Hence, the authors recommended IMN because of its cosmesis, short operation time, and procedure simplicity [10]. However, these issues are still under discussion.

The other key trend, ultrasound, has revolutionized the practice of regional anesthesia and improved the safety and success of brachial plexus blocks by visualizing the relationship between the anatomical structures and the needle [11]. An observational prospective study has shown that the safety of pediatric regional anesthesia in blocks under general anesthesia in children is comparable to that in awake and sedated children [12]. This study also showed that the patients aged 10 to 18 years (the oldest group in this study) had more peripheral nerve blocks while awake and sedated than younger patients. Therefore, the treatment strategy for fractures in adolescents using regional anesthesia under sedation and awake has the potential to be effective.

In the Tokai region of Japan, orthopedic surgeons have traditionally performed regional anesthesia (mainly axillary brachial plexus blocks) themselves for fracture reduction and surgical anesthesia. In recent years, these blocks have been mostly performed with the use of ultrasound-guided techniques, and children over 10 years of age with good comprehension are similarly treated with regional anesthesia. Despite these characteristics, to our knowledge, there have been no reports on surgical and anesthesia trends for diaphyseal forearm fractures in the adolescent population in Japan over the past decade and the impact of COVID-19 in 2020 is unknown.

This study aimed to investigate recent surgical and regional anesthesia trends of diaphyseal forearm fractures in patients 10 to 16 years of age in Japan through a multicenter epidemiological survey from 2011 to 2020.