الفهرس | Only 14 pages are availabe for public view |
Abstract Fractures of the shaft of the radius and ulna are among the most common orthopedic injuries seen in the pediatric population. Most of these fractures can be adequately treated with closed reduction and casting.(1) However, there is a risk for loss of reduction and malunion leading to potential disability. (2) Current indications for surgical treatment of pediatric forearm fractures include open fractures, fractures with associated ipsilateral humerus (the so-called floating elbow), fractures with excessive soft tissue swelling or neurovascular compromise precluding cast immobilization, and unstable fractures failing closed treatment. (3) There is still controversy as to whether fixation of the ulna or radius alone is adequate to restore and maintain stability in fractures of both bones of the forearm, and whether it has comparable complication rates. (4) This study was designed as a systematic review of the available literature that compared the efficacy of treating unstable both bone fractures using either single bone fixation or both bone fixation. Methods We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. Eligibility criteria and study selection in meta-analysis followed the inclusion and exclusion criteria, all published articles were screened with no restrictions for data of search. Titles and abstracts were done in two parts, followed by full-text screening. Reference lists of the included studies were manually screened to find any other eligible studies that may be omitted from previous steps. Risk of bias was evaluated by the Cochrane handbook of systematic reviews; the cohort and case controls of the included studies is prospective or retrospective cohort which was evaluated by Quality assessment of cohort and case controls studies by NIH tool Data extraction. Outcome measures we focused on included mean surgical time in minutes, postoperative mean union-time, post operative complication, loss of rotation, nonunion, risk of nail removal, risk of infection, risk of refraction, risk of neuropraxia, and angular deformity. Results Meta-analysis was conducted on eight final studies and results showed that single bone fixation is an effective procedure that appears to have as good results as both bone fixation for treating unstable forearm both bone fractures in children with significantly shorter operative time. Conclusion Based on meta-analysis, there appears to be no significant difference in loss of rotation, union time, or complications between single bone and both bone fixation. On the other hand, patients treated by single bone fixation showed significantly shorter operative time and less exposure rate to intraoperative radiation by fluoroscopy however, they exhibited a trend toward re-angulation which can be controlled by additional manipulation and casting, The reason for which long-term studies are required. Study design Systematic review and meta-analysis study. |