To bury or not to bury the k-wires after fixation of a pediatric both bone forearm fracture, a randomized controlled trial

Abstract

Abstract Objectives The primary objective was to compare refracture incidence of both radius and ulna fracture in two groups treated using intramedullary k-wires where the wires were buried in group I and left exposed in group II. The secondary objective was to compare the final functional outcomes and complications incidence. Methods Between March 2019 and February 2021, 60 pediatric patients presented with unstable radius and ulna fractures amenable to surgical intervention using intramedullary K-wires were randomized into Group I (k-wires were buried under the skin) or group II (k-wires were exposed above the skin by 2 cm). In group I, k-wires were removed after full union under general anesthesia as a day case procedure; in group II they were removed in the outpatient clinic. Functional outcome per Price criteria was reported at one-year follow-up. Results Included patients had a mean age of 7.6 years (range 5 to 10). The mean operative time was significantly higher in group I (32.33 ± 7.51 vs. 36.77 ± 8.70 minutes, P = 0.03), no difference regarding intraoperative x-ray exposure (43.12 ± 15.52 vs. 41.6 ± 11.96 seconds, P = 0.67). Fracture union was achieved after a mean of 44 ± 2.6 days in group I and 43 ± 1.87 days in group II. One patient had refracture, and two had deep infection necessitated surgical debridement in group I. All patients reported excellent scores per Price criteria and achieved full wrist and elbow ROM compared to the contralateral non-injured side. Conclusion Exposed implants are a safe option when dealing with pediatric forearm fractures with similar complications rate and functional outcomes compared to buried implants; however, it confers fewer hospital admissions.