Objectives: The aim of this study was to compare outcomes and costs between titanium elastic nails (TENs), stainless steel elastic nails (SENs), and Kirschner wires (K-wires) in the treatment of pediatric diaphyseal forearm fractures with intramedullary fixation.

Design: Retrospective cohort study.

Setting: Level 1 Pediatric Trauma Center.

Patients/Participants: A total of 100 patients (65 male and 35 female) under 18 years of age with diaphyseal forearm fractures treated with intramedullary fixation were included in the study.

Intervention: Patients received single or both bone intramedullary fixation with either TENs, SENs, or K-wires.

Main Outcome Measurements: Time to radiographic union, complication rate, surgical time, and average cost per implant.

Results: 100 patients were included in the study. 31 patients were treated with TENs, 30 with SENs, and 39 with K-wires. No significant difference in time to radiographic union, complication rate, or surgical time was found between the three types of fixation. Average time to union was 9.4 weeks +/- 5.4 weeks and complication rate was 12.9% for TENs, 10.0% for SENs, and 12.8% for K-wires. There was a significant difference in cost per implant, with an average cost of $639, $172 and $24 for TENs, SENs, and K-wires respectively (p<0.001).

Conclusions: The present study demonstrates no difference between TENs, SENs, and K-wires in the treatment of pediatric diaphyseal forearm fractures with regards to outcome, time to union, surgical time or complication rates. Given the significant cost difference between these implants, we recommend surgeons consider modifying their implant selection to help mitigate cost.

Level of Evidence: Therapeutic Level III.

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