Predictors for the necessity of open reduction in the treatment of pediatric both bone forearm fractures with elastic stable intramedullary nailing

Background and study aims Elastic stable intramedullary nailing enables stable osteosynthesis with a low rate of complications in pediatric both bone forearm fractures. Repeated unsuccessful attempts lead to unnecessary exposure to radiation. We have performed a retrospective study of pediatric patients with forearm fractures to determine predictors for the necessity of open reduction in the fixation with ESIN. Patients and methods 65 pediatric patients in whom we performed osteosynthesis with ESIN for the treatment of both bone forearm fractures were enrolled in the study. Ana analysis for gender, age at injury, location of the fracture, fracture type, radiological criteria (shortening, angulation and translation), order in which the bones were stabilized and the type of reduction was performed. Results We have had 49 (75,4%) male and 16 (24,6%) female patients with an average age of 11,5 years. 87,7% had a fracture in the middle third of the forearm, 4,6% in the proximal forearm while 7,6% had a fracture in the distal forearm. 23% had an open fracture and 77% had a closed fracture. A closed reduction was possible in 40% of patients, in 38,4% one of the bones necessitated an open reduction and in 21,56% both bones required an open reduction. Conclusions In the cases of open reduction, a significantly higher translation and shortening was recorded when radius was the first bone to be stabilized. The difference was highest when translation was greater than 100%. When ulna was the first bone to be stabilized, we have noted a significantly greater shortening. Level of Evidence – Level III (Retrospective comparative study)