Surgical strategies for treating distal diaphyseal metaphyseal fractures of the forearm in pediatric patients: A review of the current literature

Introduction: Distal diaphyseal metaphyseal fractures of the forearm have always represented a challenge in pediatric orthopedic management due to their location in an anatomical transition zone with little remodeling potential and without a defined therapeutic consensus, therefore this article aims to critically analyze the recent scientific literature regarding the surgical alternatives available for the treatment of these fractures in children, Methodology for this, a systematic review of the literature was carried out in databases such as PubMed, Scopus and ScienceDirect, including articles published between 2010 and 2024, using MeSH terms such as "Forearm Fractures", "Pediatric", "Metaphyseal-diaphyseal junction" and "Elastic intramedullary nailing" which allowed the selection of original studies, systematic reviews and relevant clinical guidelines, among the most relevant results it was found that multiple therapeutic options are highlighted, including fixation with Kirschner nails, osteosynthesis plates and antegrade elastic intramedullary nailing (a-ESIN) the latter has gained relevance due to its lower rate of refractures and faster functional recovery despite the potential risks to the posterior interosseous nerve. This allowed us to conclude that antegrade elastic intramedullary fixation is emerging as a safe and effective technique for the management of pediatric distal diaphysometaphyseal fractures, but more controlled and multicenter studies are required to consolidate the evidence.