Comparison of clinical and radiological results of titanium elastic nail and plate screw surgical treatment in pediatric forearm fractures

Purpose: Comparison of clinical and radiological results of plate screw and titanium elastic nail (TEN) techniques used in pediatric forearm radius and ulna (double bone) fracture surgery Method: Patients who underwent surgery for forearm double mid-diaphyseal fractures between the ages of 7-16 between January 2010 and December 2023 were retrospectively examined. 49 patients who met the criteria were included in the study. Patients with different fracture pathologies other than forearm fractures, metabolic diseases, and patients who did not attend outpatient clinic follow-ups regularly were not included in the study. Among the patients included in the study, plate and screw surgery was performed in 20 patients and TEN surgery was performed in 29 patients. Between both surgical techniques; We compared age, gender, fracture side (right-left), fracture type (open-closed), surgery duration, number of scopies, union time, complication rate, VAS score, cosmetic discomfort from the suture scar, and post-operative functional outcome parameters. Results: While the average age of 49 patients included in the study was 11.8 years, the average age of patients who underwent TEN was 10.7 and the average age of patients who underwent plate and screw surgery was 13.4 years. The gender distribution of the patients participating in the study was 40 (81.6%) males and 9 (18.4%) females. While the gender distribution of patients who underwent plate screw surgery is 4 girls and 16 boys, the gender distribution of patients who underwent TEN surgery consists of 5 girls and 24 boys. The severity of postoperative pain was evaluated according to the VAS score between 1 and 10 points. While the post-operative pain score was 7.6 in patients who underwent plate and screw surgery, it was 5.0 in patients who underwent TEN. The side where the fracture occurred (right-left) consisted of 11 right and 9 left patients in the plate and screw surgery group, while it consisted of 16 right and 13 left patients in the TEN group. According to the type of fracture (open-closed), 1 patient was evaluated as an open fracture and 48 patients were evaluated as a closed fracture. While the average surgical time of the plate screw technique was 76 minutes, this time was 46 minutes in the TEN group. While the number of scopes consisted of an average of 40 shots in plate and screw surgery, this number was 27 in the TEN group. While the fracture healed in 6.5 weeks (week) in patients who underwent plate and screw surgery, this time was observed to be 5 weeks in those who underwent TEN. Complications developed in 5 (10.2%) of the 49 patients included in the study, and these complications consisted of superficial infection in 2 (10%) patients as a result of plate and screw surgery and refracture in 3 (10.3) patients who underwent TEN. While 18 (90%) patients were cosmetically disturbed by the surgical scar resulting from plate and screw surgery, this number consisted of 4 (13.8%) patients in the TEN group. While the implant removal period in patients who performed TEN was 9 weeks, this period was 63 weeks for plate and screw patients. In the study where we evaluated the postoperative functional outcome according to the Price criteria, 7 (35%) of 20 patients in the plate and screw group achieved excellent results, 11 (55%) had good results, and 2 (10%) had fair results, while 22 (75.9%) patients in the TEN group achieved an excellent result. Excellent results were achieved in 7 of them (24.1%) and good results were achieved in 7 of them (24.1%). Post-operative joint range of motion (ROM) of all patients in the study was evaluated, and while supination limitation of more than 20 degrees developed in one (3.4%) patient who underwent TEN, no movement limitation developed in the other patients Conclusion: In our study comparing both surgical techniques in patients who underwent surgery for pediatric forearm mid-diaphyseal fractures: TEN surgery; We think that it is a more preferable surgery due to its short surgery time, less scopy required, shorter union time, better postoperative functional and cosmetic results, and earlier and more comfortable implant removal. However, we think that the reason why refracture, which is a major complication, is significantly higher in titanium elastic nails is due to early removal of the implant. We do not recommend removing titanium elastic nails before 6 monthsç Keywords: Pediatric forearm fractures, Titanium Elastic Nail, Plate-Screw surgery