Session V - Pediatrics

Fri., 10/6/06 Pediatrics & Spine, Paper #28, 11:24 am

Intramedullary Fixation of Pediatric Forearm Fractures: Single versus Both-Bone Surgery

Anjan R. Shah, MD (n); Rakesh Mashru, MD (n);
Linda Martin, MD (n); Martin Herman, MD (n);
Drexel University College of Medicine, St. Christopher's Hospital, Philadelphia, Pennsylvania, USA

Purpose: In an effort to minimize surgical time and exposure and reduce potential risks, our practice has begun to attempt to use intramedullary (IM) single bone fixation (SBF) over both-bone fixation (BBF) to stabilize pediatric diaphyseal forearm fractures that fail conservative treatment. This study examines clinical and radiographic parameters that may predict success of SBF and compares outcomes of SBF vs. BBF.

Method: We reviewed the records and radiographs of 34 patients with diaphyseal forearm fractures treated with IM fixation, 18 stabilized by SBF and 16 by BBF, consecutively between 1997 and 2004 at our institution. Demographics, injury description, fracture pattern, surgical treatments, and clinical and radiographic outcomes were reviewed. An acceptable outcome was defined as fracture healing with less than 10° of angulation after a single procedure, loss of rotation less than 20° compared to the opposite forearm, and normal neurovascular status.

Results: Sixteen of 16 fractures treated with BBF had an acceptable outcome. All fractures treated with BBF had angulation and translation of both bones; the radius/ulna fracture site distance varied from 0 to 3.5 cm. Fourteen of 18 fractures treated with SBF had an acceptable outcome. Of the fractures successfully treated with SBF, 7 of 14 cases had one of the fractured bones angulated without fragment translation; all cases had a distance of less than 2.2 cm between the radius/ulna fracture sites. Two patients healed with 12° and 15° of angulation without significant loss of rotation. SBF failures were attributed to technical errors (wire cut-out and poor casting) in 2 patients. Two other patients had progressive angulation of the bone not stabilized; fracture site distance was greater than 2.5 cm in these patients.

Conclusion/Significance: SBF is successful in stabilizing pediatric forearm fractures when one of the two fractured bones is angulated without translation, or when the distance between the radius/ulna fracture sites is less than 2.2 cm. Successful use of SBF requires careful patient and fracture pattern selection. BBF may be a more reliable method of treating pediatric forearm fractures despite theoretical increased risks.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.