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A Retrospective Review of 10 Years of Pediatric Both Bone Forearm Fractures: Comparison of Single Bone versus Both Bone Fixation
Tyler Keller, MD; Ashley Miller, MD; Kevin J. Little, MD
University of Cincinnati, Cincinnati, OH

Introduction: ?Both bone forearm shaft fractures are among the most common bony injuries in children. These fractures require operative treatment when a loss of reduction occurs during casting or the fracture is determined to be grossly unstable at the time of initial reduction. This study compares the treatment outcomes of fixation of both the radius and ulna to just the radius or ulna. Additionally, this study compares plate and screw fixation to elastic stabilized intramedullary nail fixation.

Methods: This retrospective study investigates patients under the age of 18 years undergoing operative fixation of both bone forearm fractures between 2003 and 2013 at our single institution. Fracture location of both the radius and ulna was compared (Image 1). Comparative analysis of time to union, complication rate, tourniquet time and overall cost of treatment were examined across different fixation types. Excluded were patients with concurrent unstable ligamentous injury (ex: Monteggia fractures), ipsilateral humerus fracture, percutaneous fixation fractures, as well as patients with incomplete follow-up data.?

Results: ?A total of 401 patients were included in the study, of which 333 patients (83.0%) received fixation of both bones, while 68 (17.0%) received single bone fixation (Figure 1). Zone 2 radius and zone 3 ulna fractures were the most frequent location (Figure 2). Patients undergoing single bone fixation had a shorter time to radiographic union compared to both bone fixation (126.7 days vs 155.1 days; p < 0.001) (Figure 3), a shorter tourniquet time (24.4 versus 38.8 minutes; p = 0.0167) and hospital encounter cost was $11,383.24 compared to $18,517.95 for the single bone fixation and both bone fixation, respectively (p<0.0001). Zone 1 fractures of the ulna had significantly higher times to union than fractures at other locations (p=0.0043). Neither the complication rates (21.0% single bone versus 18.9% both bone; p = 0.367), nor the rate of revision procedures (8% single bone, 3.3% both bone; p=0.367) were significantly different between fixation groups.

Discussion and conclusion: The most recent literature relating to single bone fixation of pediatric both bone forearm fractures remains controversial. This study demonstrates that single bone fixation may have a shorter time to union, similar complication rates, shorter operative time and less overall cost than similar patients with both bone fixation. Intraoperative assessment of stability after fixation of one bone remains the best criteria for determination of suitable patients for single bone fixation.

Image 1

Figure 1

Figure 2

Figure 3

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