Both bone forearm fractures in children are common. Treatment ranges from closed reduction and casting to intramedullary fixation of one or both bones. Other authors have proposed limited internal fixation with plates and screws. Intramedullary fixation has become the most common treatment modality for displaced of both bone forearm fractures. There have been some questions whether fixation of one or both fractures is necessary. In this study, there authors retrospectively review the patients treated with intramedullary fixation of only the ulna. The radius was treated with cast immobilization for four weeks.
Forty-eight patients were treated with single intramedullary fixation of the ulna over a fourteen year span. Thirty-eight patients were available for review. Indications for fixation where open fractures along with closed fractures that failed attempts of close reduction and cast immobilization. The indications for single bone are difficult to decipher but the attending physician opted to treat the radius without fixation as long as reduction was “accepted.” A variety of data points were included in the statistical review. There were 19 open fractures and 19 closed fractures. Most of the fractures involved the middle third of each bone. Fixation was accomplished with a variety of devices including k-wires, flexible nails and stainless steel rods. The follow-up was relatively short averaging 120 days or 4 months.
Twenty-five of the thirty-eight patients healed with <10 degrees angulation of radius. Eleven of thirty-eight had 10 to 20 degrees of angulation of the radius. Two patients had greater than 20 degrees of angulation of the radius noted on serial postoperative radiographs requiring additional treatment. At short-term clinical follow-up, 35 of 38 patients achieved 160 degrees or greater of forearm rotation. Two patients had mild restriction, while one patient had severe restrictions of pronation measuring only 30 degrees. This patient had a residual of 20 degrees of angulation of the radius.
This technique appears appropriate when after fixation of the ulna, intraoperative fluoroscopy and careful inspection of the radius reveals stability. In cases that the radial alignment is restored and remains stable during forearm rotation, single bone fixation may suffice. Adequate cast immobilization with meticulous molding is necessary to prevent any displacement of the radius. Open fractures are less likely to be treated with single bone fixation because of the loss of the soft tissue envelope. The benefits of single bone fixation are ease of technique, less forearm manipulation, and potentially a decreased incidence of forearm compartment syndrome.