Complications of intramedullary wiring of forearm shaft fractures in children.

Introduction: Forearm shaft fractures are common injuries in children (3.4\% of the total of children's fractures. The majority are treated with closed reduction ({CR}) and plaster cast application. Percutaneous Intramedullary ({IM}) wires are indicated in compound, and grossly unstable fractures, or following failed {CR}. Method: In this study, we examined the complication rate associated with {IM} wiring of these fractures in 92 children treated in our institution over a 7-year period. K wires were usually used. Results: Six percent of 3,446 forearm shaft fractures were treated with internal fixation. Ninety-two fractures had {IM} wires, 15 (16\%) of which were compound. Nerve injuries were present in 3 cases. Following treatment, there were 33 complications (36\%), with 9 cases of delayed union, and 5 cases of malunion. Infection occurred in 10 cases, refracture in 6, and failure to pass wires in 2. Growth arrest occurred in 1 patient. Discussion: {IM} wiring is a very useful and usually straightforward technique. However it is not risk-free and therefore should only be done on selected cases. Meticulous wound and pin site care is necessary to avoid infection, and fracture healing should be carefully assessed prior to and following wire removal. Careful cast technique after wire removal, or burying and retaining wires for longer, should be carried out to prevent malunion.