Osteosynthesis with Kirschner wires in the treatment of unstable forearm fractures in children

Introduction Forearm fractures make 13-18% of all injuries of the upper extremities in children. Most of them are older than 6 years. The degree of tolerance is different but children younger than 8 years can tolerate 15-20 degrees of angulation, 45 degrees of inadequate rotation and total displacement. Older children can tolerate angulation of10 degrees, 30 degrees of in adequate rotation and complete dislocation. Material and methods Over a period of five years (1995-2000) 54 children with forearm fractures (22 stable and 32 unstable fractures) were treated at the Pediatric Surgery Clinic in Novi Sad. Closed reduction and percutaneous pinning were treatments of choice in 19 patients with unstable fractures: 7 kids with only radius pinning, three kids with isolated ulnar fixation, 9 kids with pinning of both bones. Open reposition and fixation with Kirschner wires was done in 13 kids. Results In the group of 22 children with stable fractures results were excellent in 17 (77%), good in 4 (18.5%), and satisfactory in one child (4.5%). In the group of 32 children with unstable fractures excellent results were noted in 24 (75%), good in 4 (12.5%) satisfactory in 3 (9.4%) and unsatisfactory in one child (3.1%) Discussion A large number of forearm fractures in children can be treated with manual reduction and plaster immobilization into a tolerable position. However, in unstable fractures the method of choice is manual reduction with percutaneous pinning. Some authors prefer fixation of both bones, others fix only one. Conclusions Based on our experience it is concluded that orthopedic reposition and percutaneous pinning of unstable forearm fractures in children is very easy to perform, duration of intramedullar fixation is relatively short, removal of pins is also very easy without anesthesia and it requires short period of plaster immobilization. This provides faster rehabilitation and improves quality of life.