الفهرس 
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Abstract
Radius and ulna fractures, or both-bone forearm fractures, are the third most common injuries in children (1), and diaphyseal forearm fractures are common injuries that represent between 3 and 6 of all pediatric fractures (2). Approximately 75% to 84% of forearm fractures occur in the distal third with another 15% to 18% in the middle third, while 1% to 7% of cases occur in the proximal third (3). In addition, midshaft forearm fractures are the most common sites for refracture in children and among the most common sites of pediatric open fractures (4).
The aim of this study is to improve outcome of pediatric both bone forearm fractures using minimally invasive procedure by intramedullary K-wires.
The mean age was 7.05 ± 2.08 years ( 4 – 10 ). 80% of the patients were males ( 48 patients ), while 20% of the patients were females ( 12 patients ). 55% of the patients (33 patients) were right side affected, while 45% of the patients (27 patients) were left side affected. 70% of the patients (42 patients) were mid shaft fractured, 30% of the patients (18 patients) were distal shaft fractured, while 0% of patients (0 patients) were proximal shaft fractured. The time lapse before surgery in the studied patients ranged from 0 day to 14 days with a mean of 3.25 ± 4.42 days.
All fractures were fixed with the k-wires through an entry point in the radius by inserted the wire by surgical drilling through Lister’s tubercle or the radial styloid while in ulna, the wire was inserted through the tip of the olecranon. Patients were followed up for a period of six months and assessed both radiologically and clinically and at the end of the follow up period, patients were assessed by Anderson et al. criteria for assessment of functional outcome.
The final result obtained was 90% of the patients were excellent ( 54 patients ), 10% of the patients were satisfactory ( 6 patients ), 0% of the patients were unsatisfactory, and 0% of the patients were failure. There was no statistically significant difference between the final outcome and the patient’s age, sex, side affected, site of fracture, the presence of associated injuries or medical conditions, and the time lapse before surgery.
The complications that were encountered in our study are: firstly was refracture after removal of k-wires 4 weeks post-operatively in six patients (10%), which was resolved by 4 weeks cast, secondly was infection at the entry point in three patients (5%), which was resolved by daily dressing and antibiotics, finally was the k-wire missed the ulna medullary canal tract intraoperative in three patients (5%), which was resolved by inserting the wire through the head of ulna.
Conclusions
Conclusions
1. Fixation of pediatric shaft both bones forearm fractures using an percutaneous intramedullary K-wires are an effective method of treatment in selected cases.
2. K-wires are a good option for fixation of pediatric shaft both bones forearm fractures. It provides a minimally invasive method of fixation, better cosmosis and good functional outcomes.
3. All of the patients included in the study experienced complete union over the observation period, and the majority had good range of motion and strength. The procedure has low morbidity and good overall results.
Recommendations
Recommendations
We recommend future research should use a standardized objective scoring system for evaluation and should focuses on carrying out randomized clinical trials that include a sufficient number of patient.