Clinical Outcomes of Surgical Treatment for Paediatric Forearm Fractures: A Retrospective Analysis of 86 Fractures.

Background

Surgical treatment of paediatric forearm fractures is usually based on age and fracture type. Most patients undergo intramedullary and, occasionally, conventional pinning or plate fixation. However, the optimal fixation method remains controversial. We retrospectively examined the clinical and radiographic outcomes and complications associated with pinning (intramedullary and conventional) and plate fixation.

Methods

Surgery was performed for 86 diaphyseal fractures of the forearm in 60 patients aged ≤ 15 years. Their mean age and follow-up duration were 8.7 years and 10.4 months, respectively. Surgical methods, fracture location, Grace and Eversmann rating, bone union, refracture and duration of postoperative immobilisation were retrospectively examined.

Results

Pinning fixation using a K-wire was performed in 62 fractures. Intramedullary pinning was performed in 47 fractures, conventional pinning in 12 and combined intramedullary and conventional pinning in 3. Meanwhile, 24 fractures were managed with plate fixation. The outcomes of each technique were often excellent based on Grace and Eversmann ratings. Delayed union or nonunion was observed in five fractures managed with open reduction and pinning fixation (n = 2, distal third of the radius; n = 1, middle third of the radius and n = 2, middle third of the ulna). All fractures treated by pinning with closed reduction or plate fixation exhibited bone union without delay. Refracture occurred in one patient treated with pinning and another treated with plate fixation. The mean postoperative immobilisation duration for plate fixation was significantly shorter than that for pinning fixation (3.2 vs. 6.7 weeks).

Conclusions

Pinning and plate fixation yield satisfactory clinical outcomes. However, pinning fixation, which requires open reduction, results in poor bone union. From the standpoint of bone union, plate fixation is recommended after open reduction. Level of Evidence: Level III (Therapeutic).