Functional Outcome of Radius and Ulnar Shaft Fractures Treated With Intramedullary Kirschner’s Wire Fixation in Children

Introduction: Fractures are a common occurrence in childhood, with approximately one-third of boys and girls sustaining at least one fracture before the age of 17. Both-bone forearm fractures, particularly those involving the radius and ulna, are more common in the non-dominant hand and in boys and usually involve the distal portions of both bones. If not properly treated, these injuries can have a significant impact on limb function. Objective: This study aimed to determine the functional outcomes of radius and ulnar shaft fractures in children treated with intramedullary Kirschner's wire fixation, assessed using standardized, objective clinical criteria at eight weeks postoperatively, and to analyze associated demographic and fracture-related factors and postoperative complications. Materials and methods: This descriptive study was conducted in the Department of Orthopedic Surgery at Bacha Khan Medical College/Mardan Medical Complex, Mardan, over a seven-month period from March 8, 2024, to October 8, 2024. During this time, a total of 348 pediatric patients aged four to 14 years presented with diaphyseal forearm fractures, of whom 209 were successfully managed non-operatively with closed reduction and casting. The remaining 139 children (both genders), whose fractures were deemed unstable after attempted closed reduction - defined radiographically as angulation >10°, displacement >50%, or rotational malalignment - were included in this study. Both open and closed fractures meeting these criteria were eligible. Functional outcomes following intramedullary Kirschner wire fixation were systematically assessed at an eight-week postoperative follow-up. Outcomes were categorized as excellent, good, fair, or poor based on objective clinical assessment, which included measurement of elbow and forearm range of motion, evaluation of pain, presence of residual deformity, and ability to return to age-appropriate daily activities, using standardized institutional criteria. Results: The mean age of the participants was 8.75 ± 2.97 years. Regarding functional outcomes, 99 children (71.2%) achieved an excellent result, 20 (14.4%) had a good outcome, 13 (9.4%) had a fair outcome, and seven (5%) had a poor outcome. Functional outcomes were slightly better in younger children (aged four to nine years) and in males, although the differences were not statistically significant. No major postoperative complications, defined as those requiring reoperation or resulting in permanent functional impairment, were observed during the eight-week follow-up. Minor complications such as transient pin tract infections and minor wire migration were noted but resolved without additional surgery. Conclusion: Intramedullary Kirschner wire fixation proved to be an effective treatment for unstable radius and ulnar shaft fractures in children, resulting in predominantly favorable functional outcomes. The majority of patients demonstrated excellent recovery with minimal complications, supporting the procedure's reliability and safety in the pediatric population. Outcomes were consistent across age groups and genders, with slightly better results observed in younger children and those with early intervention. Future multicenter studies with larger sample sizes and longer-term follow-up are recommended to validate these findings and further refine treatment protocols for pediatric forearm fractures.