COMPARATIVE ANALYSIS OF TREATMENTS FOR FOREARM FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Airton Pereira da Costa1, Erika Tonarelli Rodrigues1, Hassan Ahmad Hauache1

  • 1Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Departamento Ortopedia e Traumatologia, Sao Paulo, SP, Brazil.

Acta Ortopedica Brasileira
|November 12, 2025
PubMed

Insights

This systematic review compared intramedullary fixation methods for pediatric forearm fractures. While TEN rods and Kirschner wires reduced surgical time, they also increased adverse events, necessitating careful treatment selection.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Orthopedics
  • Evidence-Based Medicine

Background:

  • Forearm fractures are common in children, requiring effective surgical fixation.
  • Intramedullary fixation using TEN rods or Kirschner wires are common surgical options.
  • Clinical outcomes and complication rates vary between fixation methods.

Purpose of the Study:

  • To systematically review and compare clinical outcomes of intramedullary fixation with TEN rods versus Kirschner wires in pediatric forearm fractures.
  • To assess adverse events, surgical time, and fracture consolidation time.
  • To provide evidence for optimal treatment selection in pediatric forearm fractures.

Main Methods:

  • Systematic literature review across Pubmed/Medline, Science Direct, and Scielo databases.
  • Quality assessment of included trials using the MINORS tool.
  • Meta-analysis of data from 16 selected studies (1,075 patients) using R software.

Main Results:

  • Meta-analysis showed a significant increase in adverse events with TEN rods compared to Kirschner wires (RR 1.35).
  • Surgical time was significantly reduced with TEN rods (mean difference -12.42 to -21.62 minutes).
  • Fracture consolidation time showed a non-significant increase with TEN rods (mean difference 0.99). Moderate to high heterogeneity was observed (I² 73%).

Conclusions:

  • Intramedullary fixation with TEN nails and Kirschner wires yields diverse clinical outcomes and complication profiles.
  • The choice of fixation method requires careful consideration of patient-specific factors and fracture characteristics.
  • Further research may be needed to clarify optimal fixation strategies given observed heterogeneity.