Abstract
Purpose
Intramedullary (IM) nailing and plating are recognised fixation methods for both-bone midshaft forearm fractures. Although both methods are effective, IM nailing has recently been the accepted operative treatment for the paediatric population. The aim of the study was to compare the differences in the radiographic and functional outcomes of an age- and sex-matched cohort of children following treatment by IM fixation or plate fixation with screws for an unstable both-bone diaphyseal fracture.
Methods
A retrospective study was conducted and 17 age- and sex-matched pairs of patients returned for a research review clinic. The average age of our patients was 11.6 years at follow up, with 11 boys and six girls in each group. The mean follow up was similar in both groups (IM 31.5 months, plating 31.8 months).
Results
Plating and IM nailing result in good or excellent functional and radiological outcomes. Radiographs at the review clinic showed complete healing in the plating group, with reconstitution of the radial bow. Three patients in the IM group did not regain the natural radial bow radiographically. There were no significant differences between both groups for maximum radial bow and its location (P > 0.05). However, the maximum radial bow was significantly different from normative values in both groups (P = 0.003 plate, P = 0.005 IM). No non-union or malunion was observed. There were no significant differences in the loss of forearm motion and grip strength between both groups. There was no difference in the Pediatric Orthopaedic Society of North America (POSNA) scores between both groups. The plating group had a significantly worse Manchester scar score than the IM group (P = 0.012). One major complication was observed in each group: osteomyelitis for IM fixation and ulnar never palsy for plating.
Conclusion
Our study suggests that functional outcome is likely to be equivalent, regardless of which method of internal fixation is used.
Similar content being viewed by others
References
Rennie L, Court-Brown CM, Mok JY, Beattie TF (2007) The epidemiology of fractures in children. Injury 38(8):913–922
Voto SJ, Weiner DS, Leighley B (1990) Redisplacement after closed reduction of forearm fractures in children. J Pediatr Orthop 10(1):79–84
Price CT, Scott DS, Kurzner ME, Flynn JC (1990) Malunited forearm fractures in children. J Pediatr Orthop 10(6):705–712
Zionts LE, Zalavras CG, Gerhardt MB (2005) Closed treatment of displaced diaphyseal both-bone forearm fractures in older children and adolescents. J Pediatr Orthop 25(4):507–512
Kay S, Smith C, Oppenheim WL (1986) Both-bone midshaft forearm fractures in children. J Pediatr Orthop 6(3):306–310
Daruwalla JS (1979) A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 139:114–120
Fuller DJ, McCullough CJ (1982) Malunited fractures of the forearm in children. J Bone Joint Surg Br 64(3):364–367
Högström H, Nilsson BE, Willner S (1976) Correction with growth following diaphyseal forearm fracture. Acta Orthop Scand 47(3):299–303
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
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
Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T (1990) Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 10(2):167–171
Pugh DM, Galpin RD, Carey TP (2000) Intramedullary Steinmann pin fixation of forearm fractures in children. Long-term results. Clin Orthop Relat Res 376:39–48
Rabinovich A, Adili A, Mah J (2005) Outcomes of intramedullary nail fixation through the olecranon apophysis in skeletally immature forearm fractures. J Pediatr Orthop 25(5):565–569
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
Cullen MC, Roy DR, Giza E, Crawford AH (1998) Complications of intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop 18(1):14–21
Luhmann SJ, Gordon JE, Schoenecker PL (1998) Intramedullary fixation of unstable both-bone forearm fractures in children. J Pediatr Orthop 18(4):451–456
Nielsen AB, Simonsen O (1984) Displaced forearm fractures in children treated with AO plates. Injury 15(6):393–396
Wyrsch B, Mencio GA, Green NE (1996) Open reduction and internal fixation of pediatric forearm fractures. J Pediatr Orthop 16(5):644–650
Fernandez FF, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A (2005) Unstable diaphyseal fractures of both bones of the forearm in children: plate fixation versus intramedullary nailing. Injury 36(10):1210–1216
Smith VA, Goodman HJ, Strongwater A, Smith B (2005) Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques. J Pediatr Orthop 25(3):309–313
Ortega R, Loder RT, Louis DS (1996) Open reduction and internal fixation of forearm fractures in children. J Pediatr Orthop 16(5):651–654
Van der Reis WL, Otsuka NY, Moroz P, Mah J (1998) Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop 18(1):9–13
Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM (2008) Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop 28(4):403–409
Slongo TF, Audigé L; AO Pediatric Classification Group (2007) Fracture and dislocation classification compendium for children: the AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma 21(10 Suppl):S135–S160
Mathiowetz V, Wiemer DM, Federman SM (1986) Grip and pinch strength: norms for 6- to 19-year-olds. Am J Occup Ther 40(10):705–711
Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MW (1998) A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 102(6):1954–1961
Daltroy LH, Liang MH, Fossel AH, Goldberg MJ (1998) The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America. J Pediatr Orthop 18(5):561–571
Schemitsch EH, Richards RR (1992) The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am 74(7):1068–1078
Firl M, Wünsch L (2004) Measurement of bowing of the radius. J Bone Joint Surg Br 86(7):1047–1049
Tarr RR, Garfinkel AI, Sarmiento A (1984) The effects of angular and rotational deformities of both bones of the forearm. An in vitro study. J Bone Joint Surg Am 66(1):65–70
Matthews LS, Kaufer H, Garver DF, Sonstegard DA (1982) The effect on supination–pronation of angular malalignment of fractures of both bones of the forearm. J Bone Joint Surg Am 64(1):14–17
Chapman MW, Gordon JE, Zissimos AG (1989) Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am 71(2):159–169
Schmittenbecher PP, Fitze G, Gödeke J, Kraus R, Schneidmüller D (2008) Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 28(3):303–306
Richards RR (1996) Chronic disorders of the forearm. J Bone Joint Surg Am 78(6):916–930
Flynn JM, Waters PM (1996) Single-bone fixation of both-bone forearm fractures. J Pediatr Orthop 16(5):655–659
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
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
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Teoh, K.H., Chee, YH., Shortt, N. et al. An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture. J Child Orthop 3, 367–373 (2009). https://doi.org/10.1007/s11832-009-0197-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11832-009-0197-2