Prospective comparative study of three internal fixation methods for treatment of both-bone forearm fractures in older children

Abstract

Objective To evaluate and compare the outcomes of three internal fixation methods, ulna compression plate and radial elastic stable intramedullary nailing (ESIN), double ESIN and double plating, for the treatment of both-bone forearm fractures in older children. Methods From February 2004 to July 2008, 45 older children with both-bone forearm fractures that failed manual closed reduction or were unstable were recruited for the prospective comparative study. They were randomized into 3 groups with 15 each: who were treated with ulna compression plate and radial elastic stable intramedullary nailing (ESIN) (group A), double ESIN (group B) and double plating (group C). The intraoperative and perioperative indexes, the radiographic findings, the clinical outcomes and postoperative complications were compared. Results Group A and group B resulted in a lower blood loss and shorter surgery time than group C (statistically significant). However no significant differences were found between group A and group B. There was statistically significant difference on tourniquet use time among the three groups, group B being shorter than group A and group C. There was no significant difference on postoperative pain score within 5 days after the surgery among the three groups. Fracture union rate of group A at 3 months was significantly higher than group B, while no significant differences were found between group B and group C and between group A and group C. There was no statistically significant difference on fracture union among the three groups at 6 months. The incidence of loss of forearm rotation and complications was lower in group A than in group B and group C, however the difference was not statistically significant. Conclusion Based on surgery trauma, incidence of fracture union, clinical outcomes and complications, ulna compression plate and radial elastic stable intramedullary nailing shows superiority in the treatment of both-bone forearm fractures in older children. However double ESIN has the advantages of being minimally invasive and easy for secondary hardware removal. Key words: Fractures; bone; Child; Prospective studies; Literal fiatior