A Review of Surgical Management Affecting Forearm Rotation after Both Bone Forearm Fracture in the Pediatric Athlete: Plate versus Nail

The purpose of this article is to review the outcomes of surgical fixation of pediatric both bone forearm fractures with intramedullary nailing versus plating in regards to forearm rotation and its effect on athletic performance. The majority of pediatric both bone forearm fractures can be treated nonoperatively with closed reduction and immobilization; however certain displacement parameters will benefit from operative fixation. Controversy exists on whether to fix both bone forearm fractures with intramedullary nailing or with plates and screws. Historically, it has been shown that the decrease in forearm rotation with intramedullary nailing does not affect function when performing activities of daily living, but this does not account for the rotation needed by pediatric athletes to perform specific actions such as shooting a basketball or pitching a baseball. While the more anatomic reduction with plating has led to greater ranges of forearm rotation, there has yet to be a consensus on the preferred treatment in the high demand pediatric athlete. We recommend further research examining the effects of decreased pronosupination on sport-related function in athletes that had undergone surgical intervention for both bone forearm fractures in childhood or adolescence.