Percutaneous Transphyseal Intramedullary Pinning for Displaced Diaphyseal Forearm Fractures in Children

Abstract

Background: A prospective analysis of a case series of diaphyseal forearm fractures in children treated with percutaneous transphyseal intramedullary pinning is presented. Methods: Between 2004 and 2006, 30 children aged 9-15 years with displaced diaphyseal forearm fractures underwent percutaneous transphyseal intramedullary pinning. Both bones were fractured in 25 patients, four fractured only the radius, and one experienced ulna fracture. Eleven candidates had irreducible fractures, 13 had loss of reduction, and six had open fractures. Contoured Kirschner wires or Steinmann pins were introduced proximal to distal into the ulna and distal to proximal into the radius. All fractures were immobilized postoperatively with an above-elbow plaster cast for 4 weeks followed by a short-arm plaster cast for 2-4 weeks. Results: Closed reduction and pinning was successful in 20 cases, including 15 double-bone fractures and five single-bone fractures. Open reduction was completed in four fractures of both bones, and in six single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. The ROM of the forearms was evaluated using the Daruwalla grading criteria. Excellent results were reported in 96% without significant complications after a mean follow-up of 20 months. Conclusion: Percutaneous transphyseal intramedullary pinning of pediatric forearm fractures revealed several advantages, including ease of application, a small incision for insertion and removal of instrumentation, a low rate of complications, unhindered bone healing, and good clinical and radiological results. This method is convenient, effective, and safe without any deleterious effects on subsequent growth of the radius and ulna.