Treatment of Pediatric Both-Bone Forearm Fractures

Abstract

Both-bone forearm fractures of the radius and ulna are a common injury in children. Closed reduction and casting has historically been the primary means of treatment in over 90% of these fractures. Unstable and irreducible fractures, however, often pose a therapeutic challenge, with little data available to compare outcomes. The authors performed a retrospective review of 50 children with both-bones fractures treated with closed reduction and cast immobilization, open reduction and internal fixation (ORIF), or intramedullary (IM) nailing. Complications were tabulated and separated by treatment modality and subdivided into minor/major complications. Statistical regression was performed. There were 54 operations in 50 patients with both-bones fractures. All fractures healed within 8 to 10 weeks, except for two delayed unions and one nonunion. The complication rate was 5% for closed treatment, 33% for ORIF, and 42% for IM nailing. Complication rates were significantly different between the closed and operative groups. When comparing treatments in pediatric both-bones fractures, there are significantly more complications with operative techniques. Patients with ORIF had more major complications, often requiring a return to the operating room. IM nailing, when done correctly, is as acceptable and safe a form of treatment.

Open Intramedullary Kirschner Wire versus Screw and Plate Fixation for Unstable Forearm Fractures in Children

“…Its advantages included better cosmesis (shorter incision scars), shorter operating times (because of simpler technique), easier hardware removal, and cheaper implant costs. [13][14][15] Our study has limitations. It was retrospective, confined to limited numbers of patients (some of whom were lost to follow-up), and the operations were performed by different surgeons.…”

“…The results of intramedullary nailing versus plating for unstable forearm fractures have also been compared. [13][14][15] We aimed to compare the outcomes of intramedullary Kirschner wiring with plating for unstable forearm fractures in children aged older than 10 years. Operations were performed by 3 surgeons, each of whom chose the fixation technique independently.…”

An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture

“…Although there have been a small number of studies comparing both methods of open reduction and internal fixation in the paediatric population, the numbers for each group are often unequal [18][19][20][21][22][23]. In addition, these studies are deficient in relating radiographic endpoints to functional outcomes, and outcome measures are usually subjective and arbitrary.…”

Pediatric forearm fractures with tens: freedom of movements

“…Intramedullary fixation of forearm fractures has been long reported in the adult literature and only more recently has been applied to the treatment of forearm fractures in children. 8,9,24,25,28,[29][30][31] Amit et al described the results of treatment of 20 unstable diaphyseal fractures of the forearm in adolescent patients treated with closed intramedullary nailing. All fractures healed within 6 weeks.…”