[Management of unstable forearm shaft fractures in children]

Complete dislocation fractures of the forearm are rare in children. Operative treatment is indicated if it is an open fracture and if neurovascular injury is present. There is no accepted standard treatment--operative or nonoperative--for fractures that cannot be accurately reduced and stabilized. In the last 10 years we have operated on 37 fractures of the forearm in children. In 22 cases the indication for operative treatment was that the fractures could either not be reduced or could not be stabilized. Our results show that most fractures were not recognized as unstable (17 out of 22 cases), and therefore several reduction maneuvers (2 to 4 times) were performed before definitive stabilization was obtained via an operation. It is therefore mandatory that unstable fractures of both bones or of one bone be operated on whereas semistable fractures (one bone completely fractured) should be reduced under general anesthesia and operative standby. For the surgical treatment of unstable forearm fractures we recommend intramedullary fixation by dynamic nailing or plate osteosynthesis in younger patients (5-10 years) and open reduction and plate osteosynthesis in older patients and in open fractures or fractures with primary neurovascular impairment.