To Splint or Not to Splint

When surgical treatment is indicated, closed reduction with elastic stable intramedullary nailing (ESIN) is a widely accepted technique for managing both-bone forearm fractures in children. However, the optimal postoperative protocol-particularly the necessity and duration of immobilization-remains a matter of debate. This study aims to compare complication rates in patients with both-bone forearm fractures treated with ESIN, with or without postoperative splint immobilization. This retrospective study included 137 patients with displaced and unstable both-bone forearm shaft fractures who underwent surgical treatment with ESIN at our Department of Pediatric Surgery, Orthopedics, and Traumatology between January 2020 and August 2022. Postoperative immobilization was decided individually by the operating surgeon. Data collected included fracture etiology, healing time, complications, and final clinical outcomes. Eighty-one patients were treated with postoperative splint immobilization, while 56 patients did not receive immobilization. There was no significant difference in bone healing time between the 2 groups. However, the complication rate was higher in the splinted group (16%) compared with the nonsplinted group (5.4%). In addition, open fractures and the need for open reduction were significantly associated with an increased risk of complications. No differences were observed between the groups in terms of QuickDASH scores. Postoperative splint immobilization does not appear to be necessary to achieve satisfactory outcomes following ESIN treatment of both-bone forearm fractures in pediatric patients. It does not influence bone healing time or functional recovery and may be associated with a higher risk of complications. Open fractures and the requirement for open reduction are additional factors associated with increased complication rates. Level III-retrospective comparative study.