Management of pediatric unstable diaphyseal both-bone forearm fractures (AO 22-D4 and AO 22-D5), A comparison between the results of intramedullary nailing using titanium elastic nail systems versus K-wires in the rural Indian children: A prospective study

Abstract

Background: Forearm fractures constitute the largest group of injuries in the pediatric age group. When treating these injuries, we seek to achieve a complete union while also restoring the appropriate axis and arm length, which determine the upper limb's normal function. Intramedullary fixation (IM fixation) is becoming an increasingly common choice for fracture fixation. Aim: The aim of this study was to compare the functional and radiological results of IM nailing by Titanium Elastic Nail Systems (TENS) versus K-wire in the pediatric displaced diaphyseal both-bone forearm fracture. Settings and Design: This prospective comparative study was conducted in the department of orthopedics at a rural tertiary care center in North India from April 2016 to November 2019. Materials and Methods: In total, 44 children between the age of 8 and 12 years with displaced diaphyseal fracture of both-bone forearm either closed or open were available for follow-up and included in the study. They were divided into two groups randomly. Reduction was done under general anesthesia and fluoroscopic images. First, a close reduction was tried, and if it failed, open reduction was tried. IM fixation was done subsequently either by TENS (Group-A, n = 23) or K-wire (Group-B, n = 21). Patients were followed up for 12 months. Functional and radiological outcomes and complications were compared between both groups. Conclusions: IM nailing is a safe, effective, and valid technique in treating displaced both-bone forearm fractures in the pediatric age group. Both TENS and K-wire are equivalent in terms of clinical results, fracture union time, surgical time, or complication rates.