Sat., 10/20/07 Pediatrics/Spine, Paper #62, 3:27 pm OTA-2007
Comparison of Intramedullary Nailing to Plating for Both-Bone Forearm Fractures in Older Children
David M. Scher, MD1 (n); Keith R. Reinhardt, MD1 (n); David Feldman, MD2 (n);
Daniel Green, MD1 (n), Debra A. Sala2 (n); Roger Widmann, MD1 (n);
1Hospital for Special Surgery and 2Hospital for Joint Diseases, New York, New York, USA
Purpose: When operative stabilization of forearm fractures in older children is necessary, the optimal method of fixation is controversial. This study compared the radiographic and functional outcomes of intramedullary nailing to plating of forearm fractures in children between 10 and 16 years of age.
Methods: 31 patients who underwent operative fixation of midshaft radius and ulna fractures were divided into nailing and plating groups, and compared retrospectively according to perioperative data and patient outcome measures (fracture union at 3 and 6 months, loss of forearm rotation, restoration of radial bow magnitude and location, and complication rates).
Results: The nailing group had 19 patients with mean age 12.5 years (range, 10-14.6), and the plating group had 12 (mean age, 14.5 years; range, 11.9-16). Groups were similar for gender, arm injured, fracture location, AO/OTA classification, and number of open fractures. Duration of surgery and tourniquet use were significantly shorter in the nailing group (P = 0.037 and 0.001). No differences were found between the groups for fracture union at 3 or 6 months. At latest follow-up, radial bow magnitude was similar for the two groups and restored to normal in both. Radial bow location in the nailing group was significantly different than reported normal values (P = 0.001). Despite this, there was no difference in loss of forearm rotation between groups. Complication rates were also similar between groups, with one ulna nonunion, one compartment syndrome, and two refractures in the nailing group; and one radius and ulna nonunion, one broken plate, and two refractures in the plating group.
Conclusion and Significance: Based on similar functional and radiographic outcomes, nailing remains an equally effective method of fixation in children 10 to 16 years of age when compared to plating, and is our treatment of choice.
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.