title: Single-bone intramedullary fixation of unstable both-bone diaphyseal forearm fractures in children leads to increased re-displacement: a multicentre randomised controlled trial.
abstract: BACKGROUND
  Both-bone diaphyseal forearm fractures in children can be stabilised without cast by a flexible intramedullary nail in both the radius and the ulna. Adequate results with single-bone fixation combined with a complementary cast are also reported. However, because those results are based on a selection of children, this trial investigates whether single-bone intramedullary fixation, compared with both-bone intramedullary fixation, results in similar pronation and supination in children with an unstable diaphyseal both-bone forearm fracture.
  
  
  METHODS
  In four Dutch hospitals, 24 consecutive children aged <16 years with a displaced unstable both-bone diaphyseal forearm fracture were randomly allocated to single-bone or both-bone intramedullary fixation. Primary outcome was limitation of pronation and supination 9 months after initial trauma. Secondary outcomes were limitation of flexion/extension of wrist/elbow, complication rate, operation time, cosmetics of the fractured arm, complaints in daily life, and assessment of radiographs.
  
  
  RESULTS
  Between January 2006 and August 2010, 11 children were randomised to single-bone fixation and 13 to both-bone fixation. In the both-bone fixation group, two fractures were stabilized by only one nail. In both groups, median limitation of pronation/supination at 9-month follow-up was 5°-10°. In both groups operation time was similar but in the single-bone fixation group cast immobilisation was longer (median of 37 vs. 28 days). In four children, re-displacement of the fracture occurred in those fractures without an intramedullary nail.
  
  
  CONCLUSIONS
  These results caution against the use of single-bone fixation in all both-bone forearm fractures. This method may lead to increased re-displacement and reduced clinical results.
authors: Department of Orthopaedic Surgery, Erasmus Medical Center, Westzeedijk 361, Postbus 2040, 3000, CA, Rotterdam, The Netherlands. j.colaris@erasmusmc.nl
authors: Joost
authors: J
authors: Colaris
authors: Max
authors: M
authors: Reijman
authors: Jan Hein
authors: JH
authors: Allema
authors: Gerald
authors: G
authors: Kraan
authors: Peter
authors: P
authors: van Winterswijk
authors: Mark
authors: M
authors: de Vries
authors: Cees
authors: C
authors: van de Ven
authors: Jan
authors: J
authors: Verhaar
mesh_terms: D000293:Adolescent; D002648:Child; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011885:Radius Fractures / Q000601:surgery*; D014458:Ulna Fractures / Q000601:surgery*