Management of pediatric forearm fracture, a prospective study comparing the outcome of open reduction internal fixation with plate and screws method and closed reduction flexible intramedullary nailing method

Abstract

Background and Objectives: to compare the outcome of open reduction-internal fixation with plate and screws method and closed reduction-flexible intramedullary nailing method in the management of pediatric patients with unstable forearm fractures as regard to functional and cosmetic outcome. Patients and Methods: The final assessments of 42 pediatric patients between the ages of 5 to 15 years old, who were operated from April 2010 to February 2011 for both-bone forearm fractures in Erbil Teaching Hospital and Private Hospital with adequate follow up, were done and their medical records were prospectively evaluated. Results:42 children with unstable forearm fractures 21 were treated with open reduction and internal fixation of both radius and ulna using plate and screws (Group1)(mean age ,13years) and 21 were treated with close reduction and flexible intramedullary fixation (Group2)( mean age ,11years). Patient characteristics in the 2 groups were compared. In Four patients of Group 2, closed reduction was not possible because of soft tissue interposition that required open reduction with minimum incision at the fracture site. All patients achieved bone union; the mean union times were similar (P value=0.81), only one patient in each group had delayed union. Operating times were shorter in flexible nailing group (100 minutes in Group1 vs. 69 minutes in Group2, p<0.001). Conclusions: There was no significant difference in union rate between the methods. The functional outcome between the two groups was compared; there was no significant difference between them. Like other investigators, we also found 90.5% of excellent functional outcomes after the treatment of unstable forearm fractures by means of plating. As indicated in the literature, we found 95% of excellent functional results after flexible intramedullary nailing.