The choice of treatment for fractures of both bones depends on the overall stability. Instability is likely in the following circumstances:
- Both fractures at the same level
- Oblique fractures
- Multifragmentary fractures
- Converging fragments
- Complete displacement of one or both fractures
For further details on stability see the corresponding additional material.
Conservative treatment may be more difficult and primary operative fixation is recommended for older children (>10 years).
ESIN is often the most appropriate method for stabilizing both bones irrespective of the age of the patient and the fracture pattern. Advantages of ESIN are:
- Closed treatment
- Preservation of periosteum and hematoma
- Cast-free rehabilitation
- Sufficient stability given the rapid healing of diaphyseal bone in patients with open growth plates
Plating or external fixation may be used if ESIN is contraindicated by soft-tissue, fracture, patient or surgeon factors.
Combination of methods
Certain fracture patterns require the use of different methods for each bone. If one bone is stabilized operatively it is recommended to fix the other bone otherwise the child loses the advantage of early mobilization.
In this situation follow the links to reduction and fixation for each individual bone.