الفهرس 
A Comparative study between single bone fixation versus both bone fixation for pediatric unstable forearm fractures : A systematic review and meta-analysis
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Abstract
Fractures of the shaft of the radius and ulna are among the most common
orthopedic injuries seen in the pediatric population. Most of these fractures can be adequately treated with closed reduction and casting.(1) However, there is a risk
for loss of reduction and malunion leading to potential disability. (2)
Current indications for surgical treatment of pediatric forearm fractures include open fractures, fractures with associated ipsilateral humerus (the so-called floating elbow), fractures with excessive soft tissue swelling or neurovascular compromise
precluding cast immobilization, and unstable fractures failing closed treatment. (3)
There is still controversy as to whether fixation of the ulna or radius alone is
adequate to restore and maintain stability in fractures of both bones of the forearm, and whether it has comparable complication rates. (4)
This study was designed as a systematic review of the available literature that
compared the efficacy of treating unstable both bone fractures using either single bone fixation or both bone fixation.
Methods
We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials,
Web of Science, Embase, and Science Direct till September 2021 relevant
keywords.
Eligibility criteria and study selection in meta-analysis followed the inclusion
and exclusion criteria, all published articles were screened with no restrictions for
data of search. Titles and abstracts were done in two parts, followed by full-text
screening. Reference lists of the included studies were manually screened to find
any other eligible studies that may be omitted from previous steps.
Risk of bias was evaluated by the Cochrane handbook of systematic reviews;
the cohort and case controls of the included studies is prospective or retrospective
cohort which was evaluated by Quality assessment of cohort and case controls
studies by NIH tool Data extraction.
Outcome measures we focused on included mean surgical time in minutes,
postoperative mean union-time, post operative complication, loss of rotation, nonunion,
risk of nail removal, risk of infection, risk of refraction, risk of neuropraxia,
and angular deformity.
Results
Meta-analysis was conducted on eight final studies and results showed that
single bone fixation is an effective procedure that appears to have as good results
as both bone fixation for treating unstable forearm both bone fractures in children
with significantly shorter operative time.
Conclusion
Based on meta-analysis, there appears to be no significant difference in loss of
rotation, union time, or complications between single bone and both bone fixation.
On the other hand, patients treated by single bone fixation showed significantly
shorter operative time and less exposure rate to intraoperative radiation by
fluoroscopy however, they exhibited a trend toward re-angulation which can be
controlled by additional manipulation and casting, The reason for which long-term studies are required.
Study design Systematic review and meta-analysis study.