A novel hybrid fixation versus dual plating for both-bone forearm fractures in older children: A prospective comparative study

Clinical and Radiological Outcomes of Paediatric Forearm Fractures of the Radius and Ulna Following Fixation by Intramedullary Nailing or Plating: A Systematic Review

Ipsilateral forearm fractures of both the radius and ulna in children are one of the most common forms of injuries in this population. They often result from axial loading on the hand and wrist following a fall on an outstretched hand. These injuries can often be managed either conservatively or operatively. Non-operative management involves the use of cast immobilisation after satisfactory closed reduction. Most fractures managed conservatively have been noted to have a successful outcome. Surgical options of management include the use of intramedullary nailing (IMN), plates and screws, hybrid techniques and rarely external fixators. The purpose of this systematic review is to critically analyse the functional and radiological outcomes as well as the probability of developing a complication in children that have undergone either IMN or plating of both the radius and ulna in the paediatric population. A comprehensive electronic database search from April 2014 until April 2022 was conducted. Studies from PubMed, EMBASE and Cochrane electronic databases were retrieved. A total of 260 cohort studies with children between the ages of 5 to 17 years old were identified. After the application of both inclusion and exclusion criteria, six articles with a total of 409 patients relevant to this review were identified and analysed. There were no significant inconsistencies statistically in functional and radiological outcomes. Overall complication rate and time to fracture union were similar. Intramedullary nailing was noted to have a shorter operative and anaesthetic time, longer fluoroscopic exposure, and a better cosmetic outcome. Differences in bowing, radial bow magnitude and location had no overall bearing on rotation and daily activity. Considering the methodological limitations of this study, a larger sample size and higher level of evidence such as randomized control studies will yield a more conclusive result to resolve controversies. Based on currently available evidence, both plating and intramedullary nailing are excellent treatment modalities in both-bone forearm fractures.

Hybrid fixation with ESIN for both bone forearm fractures in adults: A case report and literature review

Objective

Both bone forearm fractures are common in children and rare in adults. The main surgical treatment is open reduction and internal fixation (ORIF) with plate, while the hybrid fixation of elastic-stable intramedullary nailing (ESIN) and the plate has been rarely reported before.

Case report

We report a case of a 29-year-old male patient with both bone forearm fractures. Temporarily closed reduction and plaster external fixation were performed in the emergency room, and the patient was admitted to the orthopedic trauma ward for surgery. The patient underwent open reduction and plate fixation of the ulna and closed reduction and ESIN fixation of the radius. The fractures healing was satisfactory and the internal fixation was removed 12 months postoperatively.

Conclusion

The hybrid fixation of ESIN and plate is an effective option for both bone forearm fractures in adults.

Comparison of Three Different Surgical Fixation Techniques in Pediatric Forearm Double Fractures

Introduction

Although forearm fractures are one of the most common fractures in children, controversy remains about the optimal fixation technique in the surgical treatment of these fractures. The aim of this study was to compare the results of pediatric patients with a forearm double fracture who underwent open reduction and internal fixation (plate-screw group), elastic intramedullary nailing to both bones (ESIN), and hybrid fixation (the radius or ulna is fixed with the help of ESIN and the other forearm bone is fixed using plate-screw).

Methods

A retrospective scan was made of the records of 51 patients with forearm double diaphyseal fractures (19 plate-screw, 18 ESIN, and 14 hybrid fixation). Comparisons were made in respect of the duration of surgery, length of the incision, duration of follow-up, time to union, functional results, and complication rates.

Results

The study results showed that the surgical incision length and operating time in the hybrid group were statistically significantly shorter than in the plate-screw group (p<0.05). No statistically significant difference was determined between the three groups in respect of the functional results (p>0.05).

Conclusion

When the hybrid fixation technique was compared with other methods, the results were equal or better in terms of surgery time, incision length, time to union, and complications. Therefore, this technique can be used as an effective and reliable method in appropriate pediatric forearm diaphyseal double fractures.