Intramedullary versus plate fixation of both bone forearm fractures in skeletally immature patients: a systematic
Ahmed Mohamed Ahmed1, Elsayed Said2, Ahmad Addosooki3
1Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt. drahmedabdou1993@gmail.com.
Insights
For pediatric bone forearm fractures, intramedullary fixation (IMF) and plate fixation (PF) show similar union rates and functional outcomes. IMF had more symptomatic hardware, while PF better restored radial bow in older children. High-quality trials are needed.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Pediatric bone forearm fractures (BBFFs) are common, often requiring surgical fixation for open, irreducible, or unstable injuries.
- Intramedullary fixation (IMF) and plate fixation (PF) are primary surgical techniques for BBFFs.
Purpose of the Study:
- To systematically review and meta-analyze existing literature comparing IMF and PF for pediatric BBFFs.
- To determine the superior fixation method based on union rates, complications, and functional outcomes.
Main Methods:
- A comprehensive search of PubMed, Scopus, Web of Science, and CENTRAL was conducted.
- Data extraction included union rates, complications, hardware removal, reoperations, and radiographic, clinical, and perioperative outcomes from 16 studies (922 patients).
Main Results:
- Both IMF and PF achieved similar union rates.
- IMF was linked to higher symptomatic hardware and early removal rates.
- Plate fixation (PF) demonstrated superior radial bow restoration, particularly in older children, but involved longer operative times and hospital stays. Functional outcomes were comparable, with better cosmesis reported for IMF.
Conclusions:
- No significant difference exists between IMF and PF for pediatric bone forearm fractures regarding union rates and functional outcomes.
- The choice between IMF and PF should consider their respective advantages and disadvantages.
- High-quality randomized controlled trials are essential to definitively establish the superiority of either fixation technique.
Background:
Both bone forearm fractures (BBFFs) are a common injury amongst the pediatric population. The main indications of surgical fixation are open, irreducible, or unstable fractures. The two most commonly used surgical techniques are closed or open reduction with intramedullary fixation (IMF) and open reduction with plate fixation (PF). The aim of this systematic review and meta-analysis was to determine which fixation method is superior for BBFFs.
Methods:
PubMed, Scopus, Web of Science, and CENTRAL were searched to identify studies comparing IMF and PF. We extracted data on union rates, complications, early hardware removal rates, reoperation rates, and radiographic, clinical, and perioperative outcomes.
Results:
Sixteen studies were included in the analysis, with a total of 922 patients (539 IMF and 383 PF). Similar union rates were achieved by both fixation technique. IMF was associated with a higher incidence of symptomatic hardware, and early hardware removal. Better restoration of the radial bow was observed with the PF group, especially in older children and adolescents. The rate of excellent function was comparable between groups, whereas better cosmesis was reported with the IMF group. Despite shorter fluoroscopy time and immobilization time, PF demonstrated longer tourniquet time, operating time, and hospital stay compared to IMF.
Conclusions:
We found no significant difference between IMF and PF in terms of union rates and functional outcomes taking in consideration the merits and demerits of each technique. High-quality randomized controlled trials are, therefore, necessary to determine the superiority of one fixation technique over the other.
Level Of Evidence:
III.
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