Intramedullary fixation using multiple Kirschner wires for forearm fractures: a developing country perspective

Outcome of elastic nailing of diaphyseal forearm fractures in adolescents after failure of conservative management

PURPOSE

This is a prospective study to evaluate the efficacy of elastic nails for the treatment of diaphyseal forearm fractures after failure of conservative management.

METHOD

In 35 patients with a mean age of 15.3 years (14-17 years), elastic nails were used for the treatment of diaphyseal forearm fractures after failure of conservative management. In 32 patients (91.4%), we performed closed reduction. In the remaining 3 (8.6%), closed reduction failed and an open reduction, through a minimal approach, was required before nailing.

RESULTS

After a mean follow-up of 31 months (range 24-48 months), 20 (60%) patients had an excellent result 10 (34.3%) patients had a good result, and two (5.7%) patients had fair result. The mean time of union was 12 weeks (range 8-15). The mean time in cast was 8.5 weeks (range 7-11). Full range of elbow movement was regained in all cases; however, supination and pronation were limited in two patients. One patient had a superficial infection at the site of entry of the ulnar nail which was successfully treated with oral antibiotics and daily dressing. Neurapraxia affecting superficial branch of the radial nerve in one patient was resolved over a period of time. One case with partial rupture of extensor pollicus longus tendon was reported. There was one case of delayed union. No cases of refracture were reported after removal of the implant.

CONCLUSION

In adolescents, intramedullary fixation by using elastic nail plus cast immobilization provides effective treatment for diaphyseal forearm fracture when closed management has failed. However, it is of special importance to follow the right indication and to pay attention to correct technical procedure.

Intramedullary nailing for diaphyseal forearm fractures in children after failed conservative treatment

PURPOSE

To evaluate treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures.

METHODS

11 male and 9 female patients aged 6 to 15 (mean, 12) years underwent intramedullary nailing using Ender nails plus cast immobilisation for fractures of both the radius and ulna after conservative treatment had failed.

RESULTS

After a mean follow-up of 24 (range, 12-30) months, results were excellent in 14 patients, good in 5, and fair in one. None was poor. The mean operating time was 36 minutes. The mean time to bone union was 10 (range, 7-12) weeks. The mean time in the cast was 6 (range, 4-11) weeks. The mean time to implant removal was 8 (range, 6-10) months. All patients regained a full range of elbow movement, except in one who had limited supination and pronation (<20 degrees) due to a degree of malrotation. Two patients had pain owing to nail protrusion. One patient had a superficial infection. One patient had transient neurapraxia.

CONCLUSION

Intramedullary nailing using Ender nails plus cast immobilisation is effective for diaphyseal forearm fractures in children after conservative treatment has failed.