Unstable diaphyseal fractures of both bones of the forearm in children: Plate fixation versus intramedullary nailing

This retrospective study evaluated the results of plating versus intramedullary fixation in the management of unstable, diaphyseal fractures of both bones of the forearm in children. Of the 64 children included, 45 were treated with intramedullary fixation, 19 with plating. Only A3 forearm fractures of the middle third or the transition zones were included; Galeazzi, Monteggia, and Greenstick fractures were excluded. Full radiological follow-up to union was obtained in all cases and 60 patients returned for clinical evaluation 32.3 months (plating) and 20.6 months (intramedullary fixation) after injury. The functional outcome did not differ significantly. In the intramedullary fixation group, we found two major complications (refracture and non-union) and nine minor complications (two delayed unions, three thumb neuropathies, two rod migrations, two skin infections). In the plate group, there were two major complications (refractures) and one minor complication (thumb neuropathy). Plating resulted in significantly worse results for surgical approach, operating times, frequency and duration of hospitalisation, and cosmetic outcome. In conclusion, intramedullary fixation of an unstable forearm fracture in skeletally immature patients is a safe, child-friendly, minimally invasive technique that allows early functional treatment with an excellent functional and cosmetic outcome.