• Arch Orthop Trauma Surg · Aug 2013

    Randomized Controlled Trial Multicenter Study

    Single-bone intramedullary fixation of unstable both-bone diaphyseal forearm fractures in children leads to increased re-displacement: a multicentre randomised controlled trial.

    • Joost Colaris, Max Reijman, Jan Hein Allema, Gerald Kraan, Peter van Winterswijk, Mark de Vries, Cees van de Ven, and Jan Verhaar.
    • Department of Orthopaedic Surgery, Erasmus Medical Center, Westzeedijk 361, Postbus 2040, 3000, CA, Rotterdam, The Netherlands. j.colaris@erasmusmc.nl
    • Arch Orthop Trauma Surg. 2013 Aug 1;133(8):1079-87.

    IntroductionBoth-bone diaphyseal forearm fractures in children can be stabilised without cast by a flexible intramedullary nail in both the radius and the ulna. Adequate results with single-bone fixation combined with a complementary cast are also reported. However, because those results are based on a selection of children, this trial investigates whether single-bone intramedullary fixation, compared with both-bone intramedullary fixation, results in similar pronation and supination in children with an unstable diaphyseal both-bone forearm fracture.Materials And MethodsIn four Dutch hospitals, 24 consecutive children aged <16 years with a displaced unstable both-bone diaphyseal forearm fracture were randomly allocated to single-bone or both-bone intramedullary fixation. Primary outcome was limitation of pronation and supination 9 months after initial trauma. Secondary outcomes were limitation of flexion/extension of wrist/elbow, complication rate, operation time, cosmetics of the fractured arm, complaints in daily life, and assessment of radiographs.ResultsBetween January 2006 and August 2010, 11 children were randomised to single-bone fixation and 13 to both-bone fixation. In the both-bone fixation group, two fractures were stabilized by only one nail. In both groups, median limitation of pronation/supination at 9-month follow-up was 5°-10°. In both groups operation time was similar but in the single-bone fixation group cast immobilisation was longer (median of 37 vs. 28 days). In four children, re-displacement of the fracture occurred in those fractures without an intramedullary nail.ConclusionsThese results caution against the use of single-bone fixation in all both-bone forearm fractures. This method may lead to increased re-displacement and reduced clinical results.

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