# Comparison of Percutaneous Intramedullary Pin Fixation and Elastic Stable Intramedullary Nails for Pediatric Forearm Fractures

## TL;DR

This study compares two surgical methods for treating pediatric forearm fractures and finds that percutaneous pinning is faster, cheaper, and avoids the need for a second surgery.

## Contribution

The study provides a novel comparative analysis of cost, operative time, and clinical outcomes between PIP and ESIN in pediatric patients.

## Key findings

- PIP had a 40-minute shorter operative time than ESIN after adjusting for fixation type.
- PIP implant charges were 10.5 times lower than ESIN ($52 vs $598).
- PIP patients preferred outpatient removal, and no second surgery was needed for implants.

## Abstract

Introduction: Percutaneously placed intramedullary pin fixation poses potential benefits to the patient in the treatment of pediatric forearm fractures; however, physicians still have concerns regarding clinical outcomes in comparison to traditional surgical management. The purpose of this study is to analyze the operative time, clinical outcomes, and costs associated with percutaneous intramedullary pinning (PIP) compared with elastic stable intramedullary nails (ESINs) in pediatric patients undergoing surgery for forearm fractures.

Materials and methods: In this single-center, retrospective comparative study, patients ≤18 years old with forearm fractures requiring surgical intervention with either PIP or ESINs were included. Operative times, treatment outcomes, complications, unplanned reoperations, and cost data were analyzed. A prospective phone survey was also conducted for patient satisfaction with PIP removal in the outpatient setting.

Results: A total of 140 patients were included in this study (26 PIP, 114 ESIN). PIP patients were significantly younger than ESIN patients (6.2 vs 11.9 years, p<0.001). After accounting for single- versus both-bone fixation, PIP operative time was 40 minutes shorter than that for ESIN (p<0.001). There was no statistically significant difference between the groups in fracture healing, complications, range of motion, or unplanned reoperations. Of the 38% (n=10) of PIP patients who responded to the phone survey, 100% preferred outpatient removal. Implant charges were 10.5 times higher for ESIN patients compared to PIP ($598 vs $52). There were no charges for outpatient pin removal in the postoperative global period, whereas elective ESIN removal in the OR had a mean charge of $10,836 (±3,891).

Conclusions: Our study supports the use of percutaneous pinning as a cost-efficient alternative to ESIN for diaphyseal forearm fractures in young pediatric patients with a mean age of six years. This technique avoids the need for surgical implant removal, decreases operative time, and significantly reduces costs without increasing complications or reoperations.