Single-bone fixation of paediatric diaphyseal both-bone forearm fractures: a systematic review

Unstable paediatric diaphyseal both-bone forearm fractures that fail conservative management are usually treated with fixation of both radius and ulna. This systematic review aimed to establish if single-bone fixation achieves results comparable to both-bone fixation and which bone should be fixed and by what method. A systematic review of the published literature was performed, searching Medline for English language studies that reported functional or radiographic outcome following single-bone fixation of either bone by any method. Eight studies met the inclusion criteria (Level of Evidence III or IV). Three studies compared single- with both-bone fixation, showing comparable functional and radiographic outcomes. Redisplacement of the radius fracture is common following fixation of the ulna, particularly with intramedullary K-wires. Flexible nails achieve better results than K-wires in intramedullary stabilisations. Outcome is good following radius fixation with plating or nailing. Plating achieves good results in either bone. Few complications are seen when the second bone was left unfixed only if reduced and stable. Single-bone fixation achieves results comparable to both-bone fixation. Fixing the radius rather than the ulna provides better outcome, regardless of the method. The second bone should only be left unfixed if reduced and stable intra-operatively.