|
|
|
« Back
Our son broke both the radius and the ulna bones of the forearm. The breaks occurred in the middle of the bone of the left arm. Fortunately, he is right handed. They performed a single-bone fixation by putting one metal rod down one bone. The other bone was left to heal without this procedure. Our question is: shouldn't they have put a rod down both bones?
|
|
Single bone fixation for double bone fractures of the forearm is considered safe and effective. As with all surgical procedures, there is always a risk that something may go wrong. To help study complications of single bone intramedullary fixation of the forearm, hand surgeons from Children's Hospital in Boston tried this technique. They used it in 48 cases of fractures of the ulna and radius in children ages four to 14.
One of the goals of the study was to identify possible risk factors for failed cases. In this way, it might be possible to screen children ahead of time and only perform the double rod fixation when absolutely needed or when the patient is at risk for malunion or nonunion.
In all 48 patients, only the ulna was stabilized with the rod. Surgeons with special training in pediatric medicine did the surgeries. Special imaging X-rays called fluoroscopy was done in the operating room to make sure the bones were stable and in place before putting a cast on the arm.
After collecting all the data on each case and analyzing the post-operative results, they found two potential risk factors for complications after single rod fixation for double bone fracture. The first was an open fracture. Open fracture refers to the fact that the two ends of the broken bone have not only moved apart but separated sideways so that they no longer line up. When this happens, the soft tissue structures around the broken ends are also affected, making it more difficult to maintain reduction.
Another potential risk factor is the cast that is applied after surgical reduction and fixation. If the cast is molded around the forearm too tightly, a condition called compartment syndrome can develop. Swelling and pressure on the soft tissue structures from a too-tight cast can cause more problems including death of tissue. Applying a cast that is too loose increases the risk of forearm movement inside the cast. During the early days of healing, movement can cause the fractured bones to distract even more. Either complication leads to a second surgery.
After looking over the results of their own study as well as the results of other studies examining single-rod fixation, the authors also saw that younger patients seem to be the best candidates for this approach. Surgeons can use these newly identified risk factors to carefully select who can be treated with the less invasive single-rod fixation for a double-bone forearm fracture.
The results of this study support the idea that single-rod fixation can be used with double bone fractures in the forearm. Fluoroscopy can be used during the surgery to confirm that the fractures are lined up and stable. Careful patient selection for this surgical technique is advised. Loss of bone reduction can result in a bone angle that limits forearm rotation. Some of this angulation can be prevented with intramedullary fixation and proper cast molding.
More studies are needed to determine long-term results of a single rod to support double forearm fractures. It would be good to have some studies that directly compare patients who are treated with a single rod vs. those who have a rod placed down through both bones. For now, it looks like certain patients can benefit from single-rod intramedullary fixation for fractures of both the radius and ulna.
|
References:
|
|
|
« Back
|
|
|
|
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
 | All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission. |
|
