Both bone form fractures are common in children. Many of these fractures are amendable to close reduction and casting. Unstable fractures or those that are irreducible require operative fixation. A variety of techniques have been advocated including intramedullary rods, percutaneous pinning, plating and external fixation. This study attempts to compare and contrast transradioulnar single Kirschner-wire fixation for unstable fractures of both of the distal bones to standard Kirschner-wire fixation of both bones.
This was a retrospective study. Surgical intervention was when: 1) the radius showed a 50% displacement or greater or a 20-degree angulation or greater accompanied by a complete ulnar fracture; 2) there was an incomplete ulnar fracture but the radius was completely displaced; 3) re-angulation occurred at follow-up. The minimum follow-up was 2 years. All pathological or open fractures were excluded. Fractures were treated either by close reduction or mini open reduction and conventional fixation (two or more crossed Kirschner wires) compared to transradioulnar single K-wire fixation. In this technique the fracture is reduced and a single pin is passed between the radius and ulna to stabilize both fractures. The advantages of the single pin technique are that the physis is avoided. Pin fixation was continued for between three and six weeks.
There were forty-one patients that met the inclusion criteria. Twenty patients were allocated to conventional cross Kirschner wire fixation and twenty-one patients to transradioulnar single Kirschner-wire fixation. Thirty-eight of the forty-one children had full functional restoration of motion about the wrist and forearm. There were very few patients that had any lose of motion or any problem with either technique. The authors conclude that single transradioulnar Kirschner wire fixation has similar results to fixation of both bones. The benefit advocated is avoidance of the growth plate. However, it has been clearly shown that smooth Kirschner wire fixation across an open growth plate has minimal morbidity. This technique should be kept in the armamentarium of pediatric upper extremity surgeons but the benefits remain to be defined. The only reason this technique is successful is the addition of the long arm cast to provide a neutralization force across the fractures. Time will tell whether this technique will become popular.
Pediatric, Forearm, Fracture, Kirschner, Fixation, Children