Navigating Challenges and Treatment Options in Diaphyseal Forearm Fractures Among Adolescents: Case Series and Narrative Review

Abstract

In this paper, we recount the medical trajectories of two male patients, both fourteen years of age, who sustained re-fractures of their radius and ulna six months post their primary diaphyseal fractures. Owing to the limited capacity for growth of the forearm bones between the ages of ten to sixteen years, many queries are engendered concerning apt treatment strategies. The pressing questions are whether these should be conservative or surgical and the precise method to be employed in surgical interventions. This discourse endeavors to demarcate preferred therapeutic options and shed light on a series of standard clinical dilemmas physicians encounter, along with an exhaustive scrutiny of existing literature.

Keywords: double plate; forearm diaphyseal fractures; fractures in children; hybrid method; intramedullary nails; re-fractures.

Figure 1. The initial adolescent male, aged 14

X-rays for the first visit, after the first surgery and 24 weeks. The patient suffered fractures in both the radius and ulna bones of the forearm, which were then surgically treated, with a Kirschner wire (K-wire) utilized for stabilization. This wire was removed 14 weeks post-surgery, and by the 24th week, the bones had fused.

Figure 2. Subsequent image of the aforementioned 14-year-old male

X-rays taken at 38 weeks, and at 2 years, revealed that the radius and ulna had re-fractured; the bones were then double-plated for stabilization within the same week. The bones fused properly post-operation and remained stable for 2 years afterward.

Figure 3. The secondary 14-year-old male

X-ray observations were made at the initial visit, 2 weeks, 12 weeks, 27 weeks, and post-surgery in the same week. The minor dislocation was noted initially, with a slight angular deformity developing by the 2-week mark. No further deformity progression was observed, and bone fusion was achieved at 12 weeks. However, a re-fracture occurred at 27 weeks, leading to the performance of a double-plate procedure.