Percutaneous fixation of fracture of both-bone forearm involving diaphysis in pediatric patients

Background: Both-bone forearm fractures are common in active pediatric populations, especially those aged 5–14 years. While conservative treatment suffices for many, unstable diaphyseal fractures often require surgical fixation. Titanium Elastic Nailing System (TENS) is increasingly favored for its minimally invasive technique, biomechanical stability, and preservation of radial bow. Objective: To evaluate the functional and radiological outcomes of percutaneous TENS fixation in pediatric diaphyseal both-bone forearm fractures, and to analyze complication rates and recovery using DASH scores and Price’s criteria. Methods: A prospective study was conducted on 40 children (ages 4–12) with diaphyseal both-bone forearm fractures at Al-Ameen Medical College. All underwent percutaneous fixation with TENS. Functional outcomes were assessed using the DASH score at 6 weeks, 12 weeks, and 6 months. Radiological evaluations included time to union and maintenance of radial bow. Results: Most patients (55%) were aged 7–9 years; 67.5% were male and 57.5% had right-sided injuries. The predominant cause was play-related trauma (50%). Mean time to surgery was 2.38 days, and radiological union was achieved at an average of 5.55 weeks. Excellent outcomes were observed in 92.5% of cases per Price’s criteria. DASH scores improved significantly from 68.74 (6 weeks) to 7.28 (6 months) (p< 0.001). Complications occurred in 12.5% of cases, all minor and resolved conservatively. No refractures or deep infections were reported. Conclusion: TENS is a reliable and minimally invasive method for treating pediatric diaphyseal both-bone forearm fractures. It offers early union, excellent functional recovery, and low complication rates, making it a preferred option in children with unstable fractures.