Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children^[*]

Abstract

Objectives Most of the fractures of the bones of the forearm in children are successfully treated conservatively with closed reduction and casting. The outcomes remain variable and the patients may require additional fracture manipulation or formal surgical intervention due to residual angulations. The present study assesses the radiological and functional outcomes of treating displaced forearm fractures in children with intramedullary flexible titanium elastic nailing.

Methods A total of 31 patients aged between 7 and 15 years old with displaced forearm fractures underwent flexible titanium elastic nailing. The patients were followed-up for a mean period of 8.51 months (range: 6–12 months) and were assessed for radiological and functional outcomes. The Price criteria were used to assess the functional outcome.

Results Out of 31 patients, 21 patients underwent closed reduction, and 10 required a minimal opening of the fracture site during reduction. A total of 29 patients had excellent results with normal forearm and elbow range of motion (ROM), and 2 patients had good results. In all patients, good radiological union was seen at an average time of 7.9 weeks. Five patients had minor complications, such as skin irritation over the prominent ulnar nail (n = 2), superficial nail insertion site infection (n = 2), and backing out of the ulnar nail (n = 1), requiring early removal.

Conclusion Flexible nailing is an efficient application of internal fixation for shaft fractures of both bones of the forearm in children, enabling early mobilization and return to the normal activities of the patients, with low and manageable complications.

Keywords

children - forearm injuries - fracture fixation intramedullary - ulna fractures - radius fractures - bone nails

^* Study conducted at the Department of Orthopaedics and Trauma Surgery, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal.

• Referências

• 1 Beaty JH, Kasser JR. Rockwood and Wilkins fractures in children. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010
• 2 Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques. J Pediatr Orthop 2005; 25 (03) 309-313
• 3 Bowman EN, Mehlman CT, Lindsell CJ, Tamai J. Nonoperative treatment of both-bone forearm shaft fractures in children: predictors of early radiographic failure. J Pediatr Orthop 2011; 31 (01) 23-32
• 4 Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop 2008; 28 (04) 403-409
• 5 Volpon JB. Osteossíntese das fraturas diafisárias da criança com hastes intramedulares flexíveis. Rev Bras Ortop 2008; 43 (07) 261-270
• 6 Alvachian Fernandes HJ, Saad EA, Reis FB. Osteosynthesis with intramedullary nails in children. Rev Bras Ortop 2015; 44 (05) 380-385
• 7 Westacott DJ, Jordan RW, Cooke SJ. Functional outcome following intramedullary nailing or plate and screw fixation of paediatric diaphyseal forearm fractures: a systematic review. J Child Orthop 2012; 6 (01) 75-80
• 8 Wall L, O'Donnell JC, Schoenecker PL. , et al. Titanium elastic nailing radius and ulna fractures in adolescents. J Pediatr Orthop B 2012; 21 (05) 482-488
• 9 Barry M, Paterson JM. A flexible intramedullary nails for fractures in children. J Bone Joint Surg Br 2004; 86 (07) 947-953
• 10 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58 (04) 453-458
• 11 Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990; 10 (06) 705-712
• 12 Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990; 10 (02) 167-171
• 13 Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop 1999; 19 (03) 329-337
• 14 Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop 2010; 30 (04) 313-319
• 15 Rodríguez-Merchán EC. Pediatric fractures of the forearm. Clin Orthop Relat Res 2005; (432) 65-72
• 16 Wilkins KE. Operative management of children's fractures: is it a sign of impetuousness or do the children really benefit?. J Pediatr Orthop 1998; 18 (01) 1-3
• 17 Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury 2005; 36 (Suppl. 01) A25-A34
• 18 Teoh KH, Chee YH, Shortt N, Wilkinson G, Porter DE. An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture. J Child Orthop 2009; 3 (05) 367-373
• 19 Yalçinkaya M, Doğan A, Ozkaya U, Sökücü S, Uzümcügil O, Kabukçuoğlu Y. Clinical results of intramedullary nailing following closed or mini open reduction in pediatric unstable diaphyseal forearm fractures. Acta Orthop Traumatol Turc 2010; 44 (01) 7-13
• 20 Parajuli NP, Shrestha D, Dhoju D, Dhakal GR, Shrestha R, Sharma V. Intramedullary nailing for paediatric diaphyseal forearm bone fracture. Kathmandu Univ Med J (KUMJ) 2011; 9 (35) 198-202
• 21 Borges JLP, Silva VC, Penteado LH. Fixação intramedular das fraturas do antebraço em crianças. Rev Bras Ortop 1996; 31 (01) 41-45
• 22 Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP. Elastic intramedullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 1998; 18 (04) 457-461
• 23 Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 1979; (139) 114-120
• 24 Matthews LS, Kaufer H, Garver DF, Sonstegard DA. The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm. J Bone Joint Surg Am 1982; 64 (01) 14-17
• 25 Tarr RR, Garfinkel AI, Sarmiento A. The effects of angular and rotational deformities of both bones of the forearm. An in vitro study. J Bone Joint Surg Am 1984; 66 (01) 65-70
• 26 Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma 2008; 65 (01) 109-115