Skip to main content
SpringerLink
Log in

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

Archives of Orthopaedic and Trauma Surgery volume 133, pages 1079–1087 (2013)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Amit Y, Salai M, Chechik A, Blankstein A, Horoszowski H (1985) Closing intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence: a preliminary report. J Pediatr Orthop 5(2):143–146

    PubMed  CAS  Google Scholar 

  2. Cullen MC, Roy DR, Giza E, Crawford AH (1998) Complications of intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop 18(1):14–21

    PubMed  CAS  Google Scholar 

  3. Luhmann SJ, Gordon JE, Schoenecker PL (1998) Intramedullary fixation of unstable both-bone forearm fractures in children. J Pediatr Orthop 18(4):451–456

    PubMed  CAS  Google Scholar 

  4. Roy DR, Crawford AH (1990) Operative management of fractures of the shaft of the radius and ulna. Orthop Clin North Am 21(2):245–250

    PubMed  CAS  Google Scholar 

  5. Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG (1999) Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop 19(3):329–337

    PubMed  CAS  Google Scholar 

  6. Verstreken L, Delronge G, Lamoureux J (1988) Shaft forearm fractures in children: intramedullary nailing with immediate motion: a preliminary report. J Pediatr Orthop 8(4):450–453

    Article  PubMed  CAS  Google Scholar 

  7. Dietz HG, Schmittenbecher PP, Slongo T, Wilkins KE (2006) AO manual of fracture management. ESIN in children

  8. Metaizeau JP, Ligier JN (1984) Surgical treatment of fractures of the long bones in children. Interference between osteosynthesis and the physiological processes of consolidation. Therapeutic indications. J Chir 121(8–9):527–537

    CAS  Google Scholar 

  9. Prevot J, Lascombes P, Ligier JN (1993) The ECMES [Centro-Medullary Elastic Stabilising Wiring) osteosynthesis method in limb fractures in children. Principle, application on the femur. Apropos of 250 fractures followed-up since 1979. Chirurgie 119(9):473–476

    PubMed  Google Scholar 

  10. Dietz JF, Bae DS, Reiff E, Zurakowski D, Waters PM (1996) Single bone intramedullary fixation of the ulna in pediatric both bone forearm fractures: analysis of short-term clinical and radiographic results. J Pediatr Orthop 30(5):420–424

    Article  Google Scholar 

  11. Flynn JM, Waters PM (1996) Single-bone fixation of both-bone forearm fractures. J Pediatr Orthop 16(5):655–659

    Article  PubMed  CAS  Google Scholar 

  12. Houshian S, Bajaj SK (2005) Forearm fractures in children. Single bone fixation with elastic stable intramedullary nailing in 20 cases. Injury 36(12):1421–1426

    Article  PubMed  Google Scholar 

  13. Lee S, Nicol RO, Stott NS (2002) Intramedullary fixation for pediatric unstable forearm fractures. Clin Orthop Relat Res 402:245–250

    Article  PubMed  Google Scholar 

  14. Myers GJ, Gibbons PJ, Glithero PR (2004) Nancy nailing of diaphyseal forearm fractures. Single bone fixation for fractures of both bones. J Bone Joint Surg Br 86(4):581–584

    PubMed  CAS  Google Scholar 

  15. Sharieff GQ, Kanegaye J, Wallace CD, McCaslin RI, Harley JR (1999) Can portable bedside fluoroscopy replace standard, postreduction radiographs in the management of pediatric fractures? Pediatr Emerg Care 15(4):249–251

    PubMed  CAS  Google Scholar 

  16. Yung PS, Lam CY, Ng BK, Lam TP, Cheng JC (2004) Percutaneous transphyseal intramedullary Kirschner wire pinning: a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children. J Pediatr Orthop 24(1):7–12

    Article  PubMed  Google Scholar 

  17. Alnaib M, Taranu R, Lakkol S, Aldlyami E, Alcelik I, Tulloch C (2011) Radius-only intramedullary nailing for both-bones diaphyseal forearm fractures in children. Acta Orthop Belg 77(4):458–463

    PubMed  Google Scholar 

  18. Kirkos JM, Beslikas T, Kapras EA, Papavasiliou VA (2000) Surgical treatment of unstable diaphyseal both-bone forearm fractures in children with single fixation of the radius. Injury 31(8):591–596

    Article  PubMed  CAS  Google Scholar 

  19. Meier R, Prommersberger KJ, van Griensven M, Lanz U (2004) Surgical correction of deformities of the distal radius due to fractures in pediatric patients. Arch Orthop Trauma Surg 124(1):1–9

    Article  PubMed  Google Scholar 

  20. Boyer BA, Overton B, Schrader W, Riley P, Fleissner P (2002) Position of immobilization for pediatric forearm fractures. J Pediatr Orthop 22(2):185–187

    PubMed  Google Scholar 

  21. Choi KY, Chan WS, Lam TP, Cheng JC (1995) Percutaneous Kirschner-wire pinning for severely displaced distal radial fractures in children. A report of 157 cases. J Bone Joint Surg Br 77(5):797–801

    PubMed  CAS  Google Scholar 

  22. Daruwalla JS (1979) A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 139:114–120

    PubMed  Google Scholar 

  23. Gibbons CL, Woods DA, Pailthorpe C, Carr AJ, Worlock P (1994) The management of isolated distal radius fractures in children. J Pediatr Orthop 14(2):207–210

    Article  PubMed  CAS  Google Scholar 

  24. Jones K, Weiner DS (1999) The management of forearm fractures in children: a plea for conservatism. J Pediatr Orthop 19(6):811–815

    PubMed  CAS  Google Scholar 

  25. Mani GV, Hui PW, Cheng JC (1993) Translation of the radius as a predictor of outcome in distal radial fractures of children. J Bone Joint Surg Br 75(5):808–811

    PubMed  CAS  Google Scholar 

  26. Maric D, Petkovic L, Tomasevic V, Bajic L, Gajdobranski D, Marcikic A (2002) Osteosynthesis with Kirschner wires in the treatment of dislocation fractures of the forearm in children. Med Pregl 55(3–4):140–145

    Article  PubMed  Google Scholar 

  27. Noonan KJ, Price CT (1998) Forearm and distal radius fractures in children. J Am Acad Orthop Surg 6(3):146–156

    PubMed  CAS  Google Scholar 

  28. Tynan MC, Fornalski S, McMahon PJ, Utkan A, Green SA, Lee TQ (2000) The effects of ulnar axial malalignment on supination and pronation. J Bone Joint Surg Am 82-A(12):1726–1731

    Google Scholar 

  29. Zimmermann R, Gabl M, Angermann P, Lutz M, Reinhart C, Kralinger F, Pechlaner S (2000) Late sequelae of fractures of the distal third of the forearm during the growth period. Handchir Mikrochir Plast Chir 32(4):242–249

    Article  PubMed  CAS  Google Scholar 

  30. Gustilo RB, Simpson L, Nixon R, Ruiz A, Indeck W (1969) Analysis of 511 open fractures. Clin Orthop Relat Res 66:148–154

    Article  PubMed  CAS  Google Scholar 

  31. Colaris J, van der Linden M, Selles R, Coene N, Allema JH, Verhaar J (2010) Pronation and supination after forearm fractures in children: reliability of visual estimation and conventional goniometry measurement. Injury 41(6):643–646

    Article  PubMed  Google Scholar 

  32. Price CT, Scott DS, Kurzner ME, Flynn JC (1990) Malunited forearm fractures in children. J Pediatr Orthop 10(6):705–712

    Article  PubMed  CAS  Google Scholar 

  33. Arnould C, Penta M, Renders A, Thonnard JL (2004) ABILHAND-Kids: a measure of manual ability in children with cerebral palsy. Neurology 63(6):1045–1052

    Article  PubMed  Google Scholar 

  34. Altay M, Aktekin CN, Ozkurt B, Birinci B, Ozturk AM, Tabak AY (2006) Intramedullary wire fixation for unstable forearm fractures in children. Injury 37(10):966–973

    Article  PubMed  Google Scholar 

  35. Jubel A, Andermahr J, Isenberg J, Issavand A, Prokop A, Rehm KE (2005) Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop B 14(5):375–380

    Article  PubMed  Google Scholar 

  36. Kapoor V, Theruvil B, Warwick DJ, Uglow MG (2004) Distal radio-ulnar joint subluxation following intramedullary nailing of the radius in a child. J Bone Joint Surg Br 86(4):592–594

    PubMed  CAS  Google Scholar 

  37. Kucukkaya M, Kabukcuoglu Y, Tezer M, Eren T, Kuzgun U (2002) The application of open intramedullary fixation in the treatment of pediatric radial and ulnar shaft fractures. J Orthop Trauma 16(5):340–344

    Article  PubMed  Google Scholar 

  38. Kumar G (2006) Comparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children. J Bone Joint Surg Am 88(8):1888 (author reply 1888–1889)

    PubMed  Google Scholar 

  39. Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26(6):827–834

    Article  PubMed  Google Scholar 

  40. Qidwai SA (2001) Treatment of diaphyseal forearm fractures in children by intramedullary Kirschner wires. J Trauma 50(2):303–307

    Article  PubMed  CAS  Google Scholar 

  41. Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP (1998) Elastic intramedullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 18(4):457–461

    PubMed  CAS  Google Scholar 

  42. Calder PR, Achan P, Barry M (2003) Diaphyseal forearm fractures in children treated with intramedullary fixation: outcome of K-wire versus elastic stable intramedullary nail. Injury 34(4):278–282

    Article  PubMed  CAS  Google Scholar 

  43. Majed A, Baco AM (2007) Nancy nail versus intramedullary-wire fixation of paediatric forearm fractures. J Pediatr Orthop B 16(2):129–132

    Article  PubMed  Google Scholar 

  44. Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM (2005) Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop 25(4):490–494

    Article  PubMed  Google Scholar 

  45. Nilsson BE, Obrant K (1977) The range of motion following fracture of the shaft of the forearm in children. Acta Orthop Scand 48(6):600–602

    Article  PubMed  CAS  Google Scholar 

  46. Price CT, Knapp DR (2006) Osteotomy for malunited forearm shaft fractures in children. J Pediatr Orthop 26(2):193–196

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

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

Authors
  1. Joost Colaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Max Reijman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Hein Allema
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerald Kraan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter van Winterswijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark de Vries
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cees van de Ven
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jan Verhaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joost Colaris.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1763-0

Keywords

search

Navigation