Intramedullary fixation for pediatric unstable forearm fractures

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Traumatology

Background:

• Diaphyseal both-bone forearm fractures are common pediatric injuries.
• Intramedullary wire fixation is a treatment option, but optimal technique requires further investigation.

Purpose of the Study:

• To evaluate the efficacy of different intramedullary wire fixation methods for pediatric diaphyseal both-bone forearm fractures.
• To determine the optimal technique for intramedullary wire fixation to minimize complications like reangulation.

Main Methods:

• Retrospective analysis of 49 children with diaphyseal both-bone forearm fractures.
• Treatment groups included: both-bone intramedullary wire fixation (24), single ulnar intramedullary wire fixation (22), and single radial intramedullary wire fixation (3).
• Fractures were classified as open (6) or closed (43); limited open approaches were used for wire insertion in some closed fractures.

Main Results:

• Both-bone and single radial intramedullary wire fixations achieved excellent results with minimal angulation (<5 degrees).
• Single ulnar intramedullary wire fixation led to progressive radial reangulation in 7 of 22 cases, requiring cast changes or revision surgery.
• Late reangulation occurred in three older patients after early wire removal.

Conclusions:

• Stabilization of both the radius and ulna with intramedullary wires is recommended for diaphyseal both-bone forearm fractures in children.
• Burying intramedullary wires is advised to prevent complications associated with early removal and to ensure long-term stability.