Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children

This retrospective review evaluates the efficacy of standard intramedullary Kirschner wires (K-wires) for the treatment of open or unstable diaphyseal forearm fractures in 32 children with a mean follow-up of 13 months. Thirt y-one patients had an excellent result, and one patient had a good result. Average time to bridging cortex was 3 months. Four patients lacked full pro nation and supination, with none lacking >20 degrees, and no patients had e vidence of growth-plate arrest. Nine complications occurred in eight patien ts: lost reduction after K-wire removal (three), refracture (two), deep inf ection (one), pin-site infection (one), transient anterior interosseous ner ve palsy (one), and skin ulcer over buried K-wire (one). Both infections oc curred in cases in which the K-wire ends were left outside the skin. Each c ase of lost reduction occurred in single-bone fixation cases when the K-wir es were removed before 4 weeks. In children, intramedullary fixation by usi ng standard K-wires plus cast immobilization provides effective treatment f or the problematic open or unstable diaphyseal forearm fracture when closed management has failed. Refinement of the technique may help to avoid compl ications. We now recommend burying the K-wires under the skin for 3-5 month s and stabilizing both the radius and ulna with an intramedullary K-wire.