The use of traction to simplify intramedullary fixation of paediatric forearm fractures

A minority of paediatric and early adolescent diaphyseal forearm fractures require operative fixation. The method of closed reduction and intramedullary stabilisation of such fractures using stainless steel pins or flexible titanium nails has well documented success rates. The literature proposing their use advises the wires are inserted with the forearm resting free on a radiolucent arm table. In our experience, this technique is demanding; the fracture sites are unstable, often with soft tissue interposition, and the proximal radial fragment is difficult to control by closed means because of the overlying muscle mass. The technique, we describe, employs a standard Maquet Orthostar traction table (Maquet, Colima Ave, Hylton Riverside, Sunderland, UK) to effect a stable closed reduction of diaphyseal forearm fractures to simplify the procedure of passing the radial wire. The traction is then released to allow elbow flexion and the ulna wire to be passed, the ulna fracture having been reduced by the traction and stabilised by the radial wire. In summary, the use of traction to reduce and stabilise the radial fracture has simplified the surgery and reduced operative time.