الفهرس 
Bony Anatomy
BiomechanicsOnly 14 pages are availabe for public view
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Abstract
Diaphyseal both bone forearm fractures are one of the most common fractures in paediatrics orthopaedics (1,2) and there are trend toward operative treatment of these fractures however the optimal method of surgical fixation in this age group remains controversial (3). The two standard modes of forearm fracture fixation are intramedullary (IM) nailing and plate fixation (10, 11). The increased level of complications of dual IM nailing in the old children and the existing undesired complications of the dual plating had led to an attractive alternative technique using an elastic intramedullary nail for radius stabilization and open reduction and internal fixation (ORIF) for the ulna, which is supposed to provide the advantages of rigid fixation by ulna plating which provide rotational stability to the forearm and advantages of nailing with minimal invasion, avoidance of periosteal stripping, sparing posterior interosseous nerve in proximal radius fractures. The purpose of this study was to evaluate anatomical and functional outcomes of Hybrid fixation (ulna plating- Radius nailing) in treatment of closed proximal radius and ulna fractures in children. This study included 41 cases of diaphyseal both bone forearm fractures treated with hybrid fixation. The age of the patients ranged from 11 to 16 years with the mean age of 14.05± 1.58. There were 37males (90.24%) and 4 females (9.76 %).The main mechanism of injury was falling on outstretched hand in 37 cases (90%). 25 patients (60.98%) had fracture in the proximal third and the others had fracture in the middle third. Right side was affected in 19 cases (46.34%) while the left side was affected in 22 cases (53.66%). The dominant side of all cases was the right side. Operation time ranged from 35 to 95 minutes with a mean time 56.71± 17.27 minutes. Open reduction of the radius was indicated in 4 cases. Evaluation of clinical outcomes according to price grading score revealed the following results: 28 cases (68.29%) had excellent function, 8 cases (19.51%) had good function, 3 cases (7.32%) had fair function, and 2 cases (4.88%) had poor function. The mean supination range was 81.86º ± 9.65º while the mean pronation range was 78.78º± 3.5º 26 patients (63.41%) had full supination range and 37 patients (90.24%) had full pronation range. Summary [122] The mean union time was 7.41±2.65 weeks ranging from 4 to 10 weeks. The radiological signs of union had appeared in the radius 2weeks earlier than in the ulna in 18 cases (46.15%). Five complications were reported in this study. 4 cases with prominent hardware, 3 cases developed neurapraxia, resolved with follow up. Two cases had non union. One of them developed nail migration and the other had the extensor pollicis longus tendon been ruptured. The final outcome was significantly affected by Age, fracture side, Mechanism of injury, operation time, Type of radius reduction, fracture site, and residual deformity (Angulation, Rotation and translation), and not affected by sex and fracture pattern. Neither maximum radial bow nor its site were restored in our study, however this didn’t affect forearm range of motion.