title: Re-displacement of stable distal both-bone forearm fractures in children: a randomised controlled multicentre trial.
abstract: BACKGROUND
  Displaced metaphyseal both-bone fractures of the distal forearm are generally reduced and stabilised by an above-elbow cast (AEC) with or without additional pinning. The purpose of this study was to find out if re-displacement of a reduced stable metaphyseal both-bone fracture of the distal forearm in a child could be prevented by stabilisation with Kirschner wires.
  
  
  METHODS
  Consecutive children aged <16 years with a displaced metaphyseal both-bone fracture of the distal forearm (n = 128) that was stable after reduction were randomised to AEC with or without percutaneous fixation with Kirschner wires. The primary outcome was re-displacement of the fracture.
  
  
  RESULTS
  A total of 67 children were allocated to fracture reduction and AEC and 61 to reduction of the fracture, fixation with Kirschner wires and AEC. The follow-up rate was 96% with a mean follow-up of 7.1 months. Fractures treated with additional pinning showed less re-displacement (8% vs. 45%), less limitation of pronation and supination (mean limitation 6.9 (± 9.4)° vs. 14.3 (± 13.6)°) but more complications (14 vs. 1).
  
  
  CONCLUSIONS
  Pinning of apparent stable both-bone fractures of the distal forearm in children might reduce fracture re-displacement. The frequently seen complications of pinning might be reduced by a proper surgical technique.
authors.affiliation: Erasmus Medical Center, Department of Orthopaedic Surgery, Postbox 2040, 3000 CA, Rotterdam, The Netherlands. j.colaris@erasmusmc.nl
authors.forename: Joost W
authors.initials: JW
authors.lastname: Colaris
authors.forename: Jan Hein
authors.initials: JH
authors.lastname: Allema
authors.forename: L Ulas
authors.initials: LU
authors.lastname: Biter
authors.forename: Mark R
authors.initials: MR
authors.lastname: de Vries
authors.forename: Cees P
authors.initials: CP
authors.lastname: van de Ven
authors.forename: Rolf M
authors.initials: RM
authors.lastname: Bloem
authors.forename: Albert J H
authors.initials: AJ
authors.lastname: Kerver
authors.forename: Max
authors.initials: M
authors.lastname: Reijman
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
mesh_terms: D001864:Bone Wires; D002370:Casts, Surgical; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D016059:Range of Motion, Articular; D013997:Time Factors; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*