Stabilization of adolescent both-bone forearm fractures: A comparison of intramedullary nailing versus open reduction and internal fixation

Objectives: To compare flexible intramedullary (IM) nailing with open reduction and internal fixation (ORIF) with plates and screws in the treatment of adolescent both-bone forearm fractures. Design: Retrospective comparative study. Setting: Level I trauma center. Patients/Participants: Sixty-one skeletally immature adolescents (mean age, 13.9 years; range, 11.5-16.9 years) treated operatively for both-bone forearm fractures from 1997 to 2007. Patients with Monteggia, Galeazzi, intra-articular, and pathologic fractures were excluded. Intervention: Forty-six patients (mean age, 14.1 years) underwent ORIF and 15 patients (mean age, 13.3 years) underwent flexible IM nailing. Main Outcome Measures: Time to fracture union, forearm rotation, magnitude and location of maximal radial bow, and complications. Results: There was no difference in mean time to union between the IM nailing (8.5 weeks) and ORIF (8.9 weeks) groups, although the study did not have sufficient power to detect a difference. Eighty-three percent of patients in both groups regained full forearm rotation. Although radial bow magnitude was comparably restored in both groups, the mean location of maximal radial bow was translated distally in the IM nailing group (67.2%) compared with the ORIF group (60.1%, P < 0.001) and a previously reported normal value (60.4%, P < 0.001). There were no major complications in the IM nailing group and five major complications in the ORIF group. Conclusions: Flexible IM nailing of both-bone form fractures in adolescents was safe and effective in our small series; we had less complications when compared with conventional ORIF. Although flexible IM nailing results in distal translation of the radial bow, forearm rotation is not compromised.