Complications of intramedullary fixation of pediatric forearm fractures

A retrospective review of 20 children with forearm fractures treated with intramedullary fixation is presented. Indications for surgery included fracture malreduction, open fracture, polytrauma, unstable fracture pattern, and compartment syndrome. Both radius and ulna were fractured in patients. Intramedullary fixation of both bones was performed in eight cases, ulna alone in nine, and isolated radius in three. A limited open approach to one or both bones was necessary for insertion of the intramedullary rod in 15 of 20 cases, including the eight open fractures. Eighteen complications occurred in 10 of 20 patients, including hardware migration, infection, loss of reduction, reoperation, nerve injury, significant decreased range of motion, synostosis, muscle entrapment, and delayed union. Despite the complications, 17 patients had excellent and two had good outcomes. Although excellent clinical results can be expected with intramedullary fixation, complications related to the surgical technique can be expected.