IMN is an effective technique for pediatric forearm fractures with good to excellent outcomes in 91%. Complications are not infrequent with this technique, with complications of grade 2 to 4 severity in 17%. There was a 2-fold increase in the rate of complications in children over the age of 10 years. Compartment syndrome was more common in younger children. Patients and families should be counseled about the risks preoperatively.

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Twenty-six skeletally immature patients with 27 displaced, diaphyseal forearm fractures treated by open reduction and internal fixation were reviewed. The mean age of the patients at the time of injury was 11.5 years (range, 4-15). Indications for surgery included open fractures (10), unacceptable closed reduction (14), and loss of reduction (three). Anatomic or near anatomic fixation was achieved with either compression plates or intramedullary wires. The average time to union was 3.5 months. The average length of follow-up was 39 months (range, 9-98). All but three patients regained full range of motion equal to that of the uninjured extremity. Three complications occurred, including one deep infection resulting in delayed union, one nonunion with failure of hardware, and one proximal radioulnar cross-union. We conclude that open reduction and internal fixation is indicated and can be safely performed in children with open or unstable or both-bone forearm fractures when closed treatment methods have failed. Fixation is reliably achieved with compression plating or intramedullary nailing.