الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Among the pediatric population, fractures of the radius and ulna diaphysis, commonly referred to as both-bone forearm fractures, are the third most common fractures in the pediatric population. There have been reports of increasing operative treatment of forearm shaft fractures due to immediate complications of non-surgical treatment such as redisplacement and loss of mobility. Placement of intramedullary fixation is the most common form of surgical fixation. Once inserted, a key decision is whether to leave a short portion of the wire primarily exposed or cut short and buried beneath the skin. The wires are usually temporary and are removed within a few weeks. The perceived advantages of burying wires include patient comfort, reduced infection rate, earlier physiotherapy, and the ability to leave the wires in for longer periods. Conversely, an advantage of exposed wires is their easy removal in the clinic rather than at a second procedure requiring anesthesia. Materials and Methods: The study is a randomized controlled trial done at the Department of Orthopedic Surgery and Traumatology, Assiut University Hospitals. Pediatric Patients with unstable both bone forearm fractures (All cases presenting to Trauma Unit over two years from March 2019 to December 2020) were included in this study. There were 60 patients in the study, Intramedullary implants were buried in 30 patients and left exposed in 30 patients. Results: The mean age of those with exposed implant 7.37 ± 1.87 years while the mean age of patients with buried implant was 7.80 ± 1.54 years. The range of age in both groups was between 5 and 10 years. The majority (80% of the unburied group and 66.7% of the buried group) were males. with exception of only two patients, all patients were Right-handed. It was found that mean operative time was significantly higher among patients with buried implant (32.33 ± 7.51 vs. 36.77 ± 8.70 (minute); P= 0.03) while both groups had insignificant differences as regard thickness of K wire (1.74 ± 0.19 vs. 1.68 ± 0.19 (mm); P= 0.22) and X ray-shots (21.56 ± 7.76 vs. 20.80 ±5.98; P= 0.67). Only four and two patients underwent open reduction from the unburied implant and buried implant, respectively.Refracture was noticed in one patient with exposed implant. None of those patients with buried implant reported refracture, malunion, or non-union. Two patients in the exposed group developed a superficial infection while a deep infection developed in 2 (6.7%) patients from the buried group. All patients had full range of motion (ROM) of elbow and wrist but time until obtaining full ROM was significantly lower in patients who underwent buried implant (1.22 ± 0.51 vs. 3.89 ± 2.61 (week); P< 0.001). Although buried implants required a second visit to OR for removal of implants, They were proven to provide an earlier recovery of range of motion of the wrist and the elbow. No statistically significant difference was found as regard complication rate. Considering the strength and limitation of this study, we strongly recommend for engagement of further studies with big sample size.