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Single-bone intramedullary fixation of unstable both-bone diaphyseal forearm fractures in children leads to increased re-displacement: a multicentre randomised controlled trial

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Both-bone diaphyseal forearm fractures in children can be stabilised without cast by a flexible intramedullary nail in both the radius and the ulna. Adequate results with single-bone fixation combined with a complementary cast are also reported. However, because those results are based on a selection of children, this trial investigates whether single-bone intramedullary fixation, compared with both-bone intramedullary fixation, results in similar pronation and supination in children with an unstable diaphyseal both-bone forearm fracture.

Materials and methods

In four Dutch hospitals, 24 consecutive children aged <16 years with a displaced unstable both-bone diaphyseal forearm fracture were randomly allocated to single-bone or both-bone intramedullary fixation. Primary outcome was limitation of pronation and supination 9 months after initial trauma. Secondary outcomes were limitation of flexion/extension of wrist/elbow, complication rate, operation time, cosmetics of the fractured arm, complaints in daily life, and assessment of radiographs.

Results

Between January 2006 and August 2010, 11 children were randomised to single-bone fixation and 13 to both-bone fixation. In the both-bone fixation group, two fractures were stabilized by only one nail. In both groups, median limitation of pronation/supination at 9-month follow-up was 5°–10°. In both groups operation time was similar but in the single-bone fixation group cast immobilisation was longer (median of 37 vs. 28 days). In four children, re-displacement of the fracture occurred in those fractures without an intramedullary nail.

Conclusions

These results caution against the use of single-bone fixation in all both-bone forearm fractures. This method may lead to increased re-displacement and reduced clinical results.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Erasmus Medical Center, Westzeedijk 361, Postbus 2040, 3000, CA, Rotterdam, The Netherlands

    Joost Colaris, Max Reijman, Peter van Winterswijk & Jan Verhaar

  2. Department of Surgery, HAGA Hospital, Den Haag, The Netherlands

    Jan Hein Allema

  3. Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands

    Gerald Kraan

  4. Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands

    Mark de Vries

  5. Department of Paediatric Surgery, Erasmus Medical Center, Rotterdam, The Netherlands

    Cees van de Ven

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  1. Joost Colaris
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Correspondence to Joost Colaris.

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Colaris, J., Reijman, M., Allema, J.H. et al. Single-bone intramedullary fixation of unstable both-bone diaphyseal forearm fractures in children leads to increased re-displacement: a multicentre randomised controlled trial. Arch Orthop Trauma Surg 133, 1079–1087 (2013). https://doi.org/10.1007/s00402-013-1763-0

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