This is a retrospective review of the use of a single intramedullary wire in the ulna versus both-bone intramedullary wire fixation for the treatment of both-bone forearm fractures. Forty-nine children were reviewed with an average age of 11 years (range, 6-14 years). Six surgeons were included in the series with the decision for single versus double pinning based on the intraoperative assessment by the surgeon. A standard technique was used with a 1.6 or 2.0 mm Kirschner wire that was left out of the skin. All 24 fractures treated with both-bone IM fixation for at least 7 weeks healed with less than 5 degrees of angulation. Two older patients required early wire removal at 5 weeks due to ulnar pin site infection that resulted in reangulation. These required remanipulation and casting. One of these patients healed with 12 degrees of angulation of the radius. Twenty-two fractures were treated with a single ulnar intramedullary wire. Seven of these patients exhibited reangulation of the radial fracture in the first 2 to 3 postoperative weeks. A remolded cast controlled the radial fracture in four of these seven patients with residual angulation between 8 and 12 degrees. Two patients underwent reoperation with either IM fixation in one patient and plate fixation in the another patient. The third patient was left with a residual 25-degree radial angulation.
Flynn and Waters in 1996 reported excellent results in 10 patients treated by one surgeon with a single intramedullary wire. Two subsequent authors had a reoperation rate of 10% due to loss of fixation. The current study revealed over a 30% reangulation rate in both-bone forearm fractures treated with a single intramedullary ulnar wire and a 9% reoperation rate. This is in sharp contrast to satisfactory alignment in all forearms treated with at least 7 weeks of dual pinning. The authors acknowledge that resident involvement in the treatment of these patients (especially with cast placement) may have impacted on their results. This study would suggest that dual pinning of both-bone forearm fractures should be the preferred technique unless the radial fracture is extremely stable. Attention to casting technique is probably important as well. Early pin removal due to skin irritation may result in a higher percent of reangulation. Pin placement below the skin should be considered in order to minimize the need for early pin removal.
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