Surgical management of adolescent both bone forearm fractures using a plate and screws versus an intramedullary elastic nail

Background Both bone forearm fractures are common injuries in children and adolescents. In adolescent patients, such fractures may be less frequently amenable to nonoperative management due to the decreased remodeling potential in children approaching skeletal maturity. These fractures are often managed surgically using intramedullary nails (IMNs) or plate fixation. Significant controversy exists between the use of the IMNs and plate fixation for diaphyseal both bone forearm fractures in adolescents. Objective This study aimed to evaluate plates and screws versus IMNs in the management of both bone forearm fractures in adolescents. Patients and methods Twenty patients were enrolled in a prospective study, 12 males and eight females, their ages ranging from 10 to 14 years (average 11.75). The mean follow-up duration was 13.2 months (ranging from 8 to 18 months). According to our protocol, patients with odd numbers (group A) were treated with plate and screws, and IMNs were used to treat those with even numbers (group B). Results The mean operative time in group A was 63.5 min (ranging from 55 to 75 min), while in group B, the mean operative time was 37 min (ranging from 35 to 45 min) (P<0.001). The mean time of use of an intraoperative image intensifier in group A was 2 s, ranging from 0 to 7 s. Comparatively, the mean time in group B was 57.5 s, ranging from 45 to 65 s, P value less than 0.001. The union time in both groups ranged from 6 to 8 weeks; the result was statistically nonsignificant. In terms of the supination and pronation range of motion (ROM), group A showed almost no change compared with the other side, at the final follow-up, while group B showed 15° mean loss in the supination ROM, ranging from 5° to 20°, with almost no loss in the pronation ROM (P=0.032). In terms of operative time for implant removal, the time needed to remove plates and screws ranged from 30 to 65 min (average 40 min), while the time needed for removal of elastic nails ranged from 10 to 18 min (average 12 min); the result was statistically significant. Conclusion IM nailing was found to be superior to plates and screws in the management of adolescent both bone forearm fractures in terms of operative time needed for fixation and removal. However, plates and screws had the advantage that they involved limited intraoperative exposure to the image intensifier. Level of evidence Level I.