An Age-matched Comparative Study on Intramedullary Nailing and Plate Fixation of Both-bone Diaphyseal Forearm Fracture in Adolescents

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2023 Aug 13

PMID 37573542

Authors

Noriko Ishihara

Katsuhiro Tokutake

Yasuhiko Takegami

Yuta Asami

Hiroaki Kumagai

Hideyuki Ota

Yoshihiko Kimura

Kazuma Ohshima

Shiro Imagama

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to compare radiological and functional outcomes and complication rates between intramedullary nailing (IMN) and plate fixation for diaphyseal forearm fractures in adolescents via an age-matched analysis.

Methods: Data were collected from medical records at 11 hospitals from 2009 to 2019, and the age-matched study was conducted between IMN and plate fixation. Functional outcomes, radiographic outcomes, and postoperative complication rates were compared.

Results: The IMN group (Group N) and plate fixation group (Group P) each comprised 26 patients after age matching. The mean age after matching was 13.42 years old. Bone maturities at the wrist of the radius and ulna were not significantly different between the two groups (p = 0.764 and p = 1). At the last follow-up period, functional outcomes using the Price criteria were over 90% in both groups, and the rotational range of motion was comparable to that of the healthy side. Over 70% of cases in Group N were performed by closed reduction, and operation time was half that of Group P. Postoperative neurological symptoms and refractures were more common in Group P than in Group N, although not statistically significantly so.

Conclusions: Treatment outcomes for age-matched adolescent diaphyseal forearm fractures were excellent with IMN, as well as with plate fixation in many cases despite fewer complications, better cosmesis, and shorter operative times with IMN. IMN for diaphyseal forearm fractures is a useful treatment option even in adolescents although the indications for the best procedure to perform should be considered depending on individual patient needs.

Level Of Evidence Iv: Multicenter retrospective study.

Citing Articles

Intramedullary versus plate fixation of both bone forearm fractures in skeletally immature patients: a systematic review and meta-analysis.

Ahmed A, Said E, Addosooki A, Attya H, Awad A, Ahmed E Eur J Orthop Surg Traumatol. 2024; 34(5):2263-2278.

PMID: 38642124 PMC: 11291663. DOI: 10.1007/s00590-024-03925-7.

References

Mann D, Rajmaira S . Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years. J Pediatr Orthop. 1990; 10(6):713-6. DOI: 10.1097/01241398-199011000-00002. View

Sinikumpu J, Lautamo A, Pokka T, Serlo W . The increasing incidence of paediatric diaphyseal both-bone forearm fractures and their internal fixation during the last decade. Injury. 2011; 43(3):362-6. DOI: 10.1016/j.injury.2011.11.006. View

Rennie L, Court-Brown C, Mok J, Beattie T . The epidemiology of fractures in children. Injury. 2007; 38(8):913-22. DOI: 10.1016/j.injury.2007.01.036. View

Truntzer J, Vopat M, Kane P, Christino M, Katarincic J, Vopat B . Forearm diaphyseal fractures in the adolescent population: treatment and management. Eur J Orthop Surg Traumatol. 2014; 25(2):201-9. DOI: 10.1007/s00590-014-1489-x. View

Teoh K, Chee Y, Shortt N, Wilkinson G, Porter D . An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture. J Child Orthop. 2009; 3(5):367-73. PMC: 2758177. DOI: 10.1007/s11832-009-0197-2. View

Flynn J, Jones K, Garner M, Goebel J . Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 2010; 30(4):313-9. DOI: 10.1097/BPO.0b013e3181d98f2c. View

Westacott D, Jordan R, Cooke S . Functional outcome following intramedullary nailing or plate and screw fixation of paediatric diaphyseal forearm fractures: a systematic review. J Child Orthop. 2013; 6(1):75-80. PMC: 3303015. DOI: 10.1007/s11832-011-0379-6. View

Baldwin K, Morrison 3rd M, Tomlinson L, Ramirez R, Flynn J . Both bone forearm fractures in children and adolescents, which fixation strategy is superior - plates or nails? A systematic review and meta-analysis of observational studies. J Orthop Trauma. 2013; 28(1):e8-e14. DOI: 10.1097/BOT.0b013e31829203ea. View

Patel A, Li L, Anand A . Systematic review: functional outcomes and complications of intramedullary nailing versus plate fixation for both-bone diaphyseal forearm fractures in children. Injury. 2014; 45(8):1135-43. DOI: 10.1016/j.injury.2014.04.020. View

10.

Slongo T, Audige L, Schlickewei W, Clavert J, Hunter J . Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association.... J Pediatr Orthop. 2006; 26(1):43-9. DOI: 10.1097/01.bpo.0000187989.64021.ml. View

11.

Price C, Scott D, Kurzner M, Flynn J . Malunited forearm fractures in children. J Pediatr Orthop. 1990; 10(6):705-12. DOI: 10.1097/01241398-199011000-00001. View

12.

Hadizie D, Munajat I . Both-Bone Forearm Fractures in Children with Minimum Four Years of Growth Remaining: Can Cast Achieve a Good Outcome at Skeletal Maturity?. Malays Orthop J. 2018; 11(3):1-9. PMC: 5753522. DOI: 10.5704/MOJ.1711.009. View

13.

Kooistra B, Dijkman B, Busse J, Sprague S, Schemitsch E, Bhandari M . The radiographic union scale in tibial fractures: reliability and validity. J Orthop Trauma. 2010; 24 Suppl 1:S81-6. DOI: 10.1097/BOT.0b013e3181ca3fd1. View

14.

Whelan D, Bhandari M, Stephen D, Kreder H, McKee M, Zdero R . Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma. 2009; 68(3):629-32. DOI: 10.1097/TA.0b013e3181a7c16d. View

15.

Kizkapan T, Misir A, Oguzkaya S, Ozcamdalli M, Uzun E, Sayer G . Reliability of radiographic union scale in tibial fractures and modified radiographic union scale in tibial fractures scores in the evaluation of pediatric forearm fracture union. Jt Dis Relat Surg. 2021; 32(1):185-191. PMC: 8073431. DOI: 10.5606/ehc.2021.78465. View

16.

Poutoglidou F, Metaxiotis D, Kazas C, Alvanos D, Mpeletsiotis A . Flexible intramedullary nailing in the treatment of forearm fractures in children and adolescents, a systematic review. J Orthop. 2020; 20:125-130. PMC: 6997658. DOI: 10.1016/j.jor.2020.01.002. View

17.

Asadollahi S, Pourali M, Heidari K . Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices. Acta Orthop. 2016; 88(1):101-108. PMC: 5251255. DOI: 10.1080/17453674.2016.1255784. View

18.

Reinhardt K, Feldman D, Green D, Sala D, Widmann R, Scher D . Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop. 2008; 28(4):403-9. DOI: 10.1097/BPO.0b013e31816d71f2. View

19.

Ridley T, Freking W, Erickson L, Ward C . Incidence of Treatment for Infection of Buried Versus Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radial Fractures. J Hand Surg Am. 2017; 42(7):525-531. DOI: 10.1016/j.jhsa.2017.03.040. View

20.

Raghavan R, Jones A, Dwyer A . Should Kirschner wires for fixation of lateral humeral condyle fractures in children be buried or left exposed? A systematic review. Orthop Traumatol Surg Res. 2019; 105(4):739-745. DOI: 10.1016/j.otsr.2019.03.007. View