Plating of a Single Bone Is Promising for the Treatment of Both-Bone Forearm Fractures in Children

Forearm fractures involving both bones are common orthopedic injuries. Children have a higher tolerance for greater displacement and angulation owing to the remodeling potential. The optimal fixation method for managing pediatric forearm fractures has not been definitively established. This study evaluated the safety and efficacy of a stepwise surgical algorithm, wherein single-bone plating was attempted first, and both-bone fixation was strictly reserved for cases demonstrating persistent intraoperative instability.

In this retrospective analysis, we evaluated 48 skeletally immature children with both-bone forearm fractures managed via our stepwise protocol. Initially, single-bone plating was performed. Dynamic manual stress testing was then applied under fluoroscopy. If the unplated bone exhibited rotational instability, residual angulation >15°, or translation >50%, the procedure was converted to both-bone plating (Group B, n = 16). Patients who achieved stable alignment without requiring a second plate formed Group A (n = 32).

Both groups achieved 100% union. Postoperative angulations of the radius on the anteroposterior view were 1.91 ± 2.73° in Group A and 0.88 ± 1.96° in Group B; meanwhile, the lateral angulation of the radius in Groups A and B was 1.88 ± 3.56° and 0.00 ± 0.00°, respectively. The anteroposterior angulation of the ulna was 2.31 ± 3.60° in Group A and 2.19 ± 4.00° in Group B, whereas the lateral angulation of the ulna was 2.81 ± 3.74° in Group A and 1.75 ± 3.47° in Group B. Only the lateral angulation of the radius showed a significant difference (p = 0.0418). In the subgroup analysis, minor differences in ulna angulation on the anteroposterior view reached statistical significance in the older cohort (p = 0.027) and in the distal-third fracture group (p = 0.001). No differences in bone healing or functional outcomes were observed, and complication rates were similar.

Our stepwise surgical algorithm appears to be a safe and effective approach. By adhering to this protocol, 66.7% of patients were successfully spared the morbidity of a second incision, while all patients achieved solid union and excellent functional outcomes. However, further high-quality studies are essential to establish comprehensive protocols for intraoperative stability assessment and postoperative care.