Related Experiment Video
Updated: Aug 18, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques
Vinson A Smith1, Howard J Goodman, Allan Strongwater
1Connecticut Children's Medical Center, Department of Orthopaedics, Hartford, CT, USA.
Insights
Pediatric both-bone forearm fractures are common. Closed reduction and casting shows fewer complications than operative treatments like open reduction and internal fixation (ORIF) or intramedullary (IM) nailing.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Surgical Outcomes
Background:
- Both-bone forearm fractures involving the radius and ulna are frequent pediatric injuries.
- Closed reduction and casting is the standard treatment for most cases.
- Unstable or irreducible fractures present treatment challenges with limited comparative outcome data.
Purpose of the Study:
- To compare complication rates and outcomes for different treatment modalities of pediatric both-bone forearm fractures.
- Evaluate the safety and efficacy of closed reduction, open reduction and internal fixation (ORIF), and intramedullary (IM) nailing.
Main Methods:
- Retrospective review of 50 children with both-bone forearm fractures.
- Fractures treated with closed reduction and cast immobilization, ORIF, or IM nailing.
- Complications were categorized by treatment type and severity (minor/major); statistical regression was performed.
Main Results:
- All fractures healed, with two delayed unions and one nonunion.
- Complication rates: 5% for closed treatment, 33% for ORIF, 42% for IM nailing.
- Operative groups (ORIF, IM nailing) had significantly higher complication rates than closed treatment.
Conclusions:
- Operative treatments for pediatric both-bone forearm fractures are associated with significantly more complications.
- ORIF resulted in more major complications requiring reoperation.
- IM nailing, when performed correctly, is a safe and acceptable alternative treatment.
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.
