Hybrid fixation for adolescent both-bones diaphyseal forearm fractures: Preliminary results of a prospective cohort study

Abstract

Introduction: Both-bone forearm fractures account for 3.4% of all pediatric fractures and 26% of all pediatric upper extremity fractures. Although non-operative management remains a feasible treatment option for children older than 10 years, they have a higher incidence for malunion due to their limited bone remodelling potential. Therefore, surgical intervention could be advocated for this age group, however the optimal method of surgical fixation in this age group remains controversial.Authors wanted to evaluate hybrid fixation (plating of ulna & elastic nail for radius) of adolescent both-bone forearm fractures in a large single-institution cohort of patients.

Methods: A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from February 2016 to February 2019.A total of 60 patients (age 10-16 years) with both-bones forearm fracture were enrolled. Patients were assessed radiographically for union as well as clinically using the "Outcome Grading System" developed by Martus et al. for functional assessment of surgical management of pediatric forearm fractures using forearm rotation range of motion & complications rate.

Results: At final follow up for each patient (24 months) Union was achieved in all cases. Delayed union occurred in 4 patients (2 radii & 2 ulnae) with no case of combined radius & ulnar delayed union. At final follow up, the mean supination range was 81.27° ± 4.1°, while the mean pronation range was 68.17° ± 3.03°. The "Outcome Grading System" results were: 48 cases (80%) scored excellent, 10 cases (16.7%) scored good & 2 cases (3.3%) scored fair.

Conclusion: Hybrid fixation method in adolescent both-bones forearm fracture could be a viable option in managing these injuries & may reduce the problem of ulnar non-union encountered when using elastic stable intramedullary nail (ESIN) in that age group.

Level of evidence: Level II, Therapeutic study.

Keywords: Fixation; Forearm; Fracture; Pediatric.

Fig. 1

Radiograph representing one case A: pre-operative AP, B: pre-operative lateral, C: Final (3 months) AP, D: final (3 months) lateral view.

Fig. 2

Clinical Picture showing forearm supination-pronation forearm range in patient whose radiographs are shown in Fig. 1. A: maximum supination, B: maximum pronation.