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Resumen: Introducción: Las fracturas diafisarias de antebrazo (FDA) en pacientes esqueléticamente inmaduros son lesiones comunes que representan el 30% de las fracturas de la extremidad superior en este grupo etario. Existen casos con lesiones inestables o reducciones inaceptables, en los cuales está indicada la resolución quirúrgica mediante la reducción y estabilización con clavos endomedulares elásticos (CEE) por vía percutánea. Una de las ventajas que ofrece este sistema es evitar un abordaje del foco de fractura, pudiendo realizar la reducción de forma cerrada en la gran mayoría de estas. Sin embargo, no siempre es posible lograr una aceptable reducción cerrada y entonces es necesaria la apertura del foco de fractura. El objetivo de este estudio fue determinar si existen factores preoperatorios para predecir la dificultad de efectuar una reducción cerrada en estos pacientes. Métodos: Se realizó un estudio retrospectivo de pacientes esqueléticamente inmaduros con FDA agudas, tratados con CEE por el mismo cirujano pediátrico. La variable de resultado primaria se definió como la necesidad de llevar a cabo una reducción abierta; considerado como un abordaje quirúrgico directo en el sitio de fractura. Se analizaron las características demográficas de los pacientes incluidos y las radiográficas de la fractura. Resultados: Encontramos que la mediana del porcentaje del acortamiento del radio preoperatorio en los grupos de reducción cerrada y reducción abierta fue del 1 y 5%, respectivamente; resultando en una diferencia estadísticamente significativa (p = 0,04). Conclusión: El acortamiento del radio en las radiografías preoperatorias permite predecir un aumento del riesgo de requerir una reducción abierta de la fractura (39% de asociación); por lo cual, esta variable debe ser considerada por el traumatólogo general como un factor pronóstico para definir la derivación de estos pacientes. Abstract: Introduction: Diaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients. Methods: A retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed. Results: We found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04). Conclusion: Radial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.

Introduction: Diaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients., Methods: A retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed., Results: We found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04)., Conclusion: Radial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients., (Copyright © 2021 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This is a retrospective study of 98 diaphyseal forearm fractures in adults, treated by a percutaneous technique with intramedullar Kirchner wires., Materials and Method: We reviewed 64 patients with 98 forearm fractures with a radiographic follow-up, assessing the presence of pseudarthrosis or delayed bone union and evaluating functional outcomes with the Anderson and the Disability of the Arm, Shoulder and Hand scale., Results: Clinical and radiological bone union was achieved in an average of 12 weeks. We obtained 77% of excellent and good results following Anderson's scale. There were 4 cases of pseudarthrosis and 6 cases of delayed bone union., Conclusion: This surgical technique provides several advantages, such as a low incidence of complications and a total absence of infections, refractures and iatrogenic neurovascular injuries. It allows a lower hospital stay and a shortening of the surgery time compared with other techniques such as plates and intramedullary nails, that have similar results, in terms of bone union and functional outcomes, as we have verified from the published literature., (Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)