Intramedullary fixation of unstable both-bone forearm fractures in children

A retrospective study was performed to evaluate the results of intramedullary fixation used in the management of unstable, diaphyseal both-bone forearm fractures in skeletally immature patients. Twenty-five patients with 25 fractures were identified whose fracture management included only intramedullary fixation. Galeazzi, Monteggia, radial head, and distal metaphyseal fractures were excluded from this analysis. Mean age at fracture was 10 + 8 years. There were 15 closed and 10 open fractures (eight grade I and two grade II). Smooth Kirschner wires or Rush rods were used for fixation. Average length of immobilization was 8 + 2 weeks; 6 + 2 in a long-arm cast and 2 + 0 weeks in a short-arm cast. All 25 regained normal elbow motion, with 17 regaining full forearm rotation. Eight patients had an average loss of 13 degrees of supination and 9 degrees of pronation. There were four minor and two major complications (one rod migration and one delayed union). No infections, malunions, or synostoses occurred in this patient group. Using the grading scheme adapted by Price there were 21 excellent results (84%), four good (16%), and no fair or poor results. In our experience, intramedullary fixation of the unstable both-bone forearm fractures is a safe, effective, and user-friendly technique when alignment jeopardizes fracture position at union and eventual forearm motion.