Elastic Stable Intramedullary Nailing in Forearm Shaft Fractures in Children: 85 Cases

Background Nearly all pediatric humeral shaft fractures can be successfully treated with closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. Methods This is a retrospective review of all traumatic humeral shaft fractures treated at our hospitals between 1999 and 2006. Thirteen pediatric patients ranging in age from 4.8 to 16.7 years (mean age 12.0 years) were treated surgically with titanium elastic nails (TENs). Relative surgical indications included open fractures, inability to maintain an acceptable reduction, the presence of ipsilateral forearm fractures (floating elbow), concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Results The patients were followed for a mean of 29 months. All fractures healed in good alignment. There were no intraoperative complications, including neurologic or vascular injury, and no patient developed an infection postoperatively. Two patients had nail migration, one of whom developed nail protrusion through the skin. One patient with preoperative radial nerve injury ultimately underwent tendon transfer to restore wrist extension. Of the 13 patients, 12 reported a full return to sports and other activities with no limitations or discomfort. Conclusions When surgical stabilization of pediatric humeral shaft fractures is indicated, TEN fixation is effective and has a high rate of union and a low rate of complications. This technique is familiar to most orthopaedic surgeons treating pediatric fractures. Level of evidence Level of evidence: IV (case series)

Section: Resultsmentioning

confidence: 99%

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Garg

Dobbs

Schoenecker

et al. 2009

“…IMN with Kirschner wires or elastic stable intramedullary nails has become popular due to improved cosmesis, shorter operative time, less soft tissue dissection and ease of removal, with good results reported [15][16][17]. Although anatomical reduction may be harder to achieve, the internal splint maintains alignment and length, whilst allowing micro-movement at the fracture site to occur, encouraging callus formation and potentially speeding union [18].…”

Section: Introductionmentioning

confidence: 99%

Functional outcome following intramedullary nailing or plate and screw fixation of paediatric diaphyseal forearm fractures: A systematic review

Westacott

Jordan

Cooke

2012

“…Intramedullary (IM) nailing [10][11][12][13][14][15][16] and plate fixation with screws [17,18] are recognised operative management of mid-shaft forearm fractures and have been reported to be effective methods in treating paediatric midshaft forearm fractures. Although there have been a small number of studies comparing both methods of open reduction and internal fixation in the paediatric population, the numbers for each group are often unequal [18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

An age- and sex-matched comparative study on both-bone diaphyseal paediatric forearm fracture

Teoh

Chee

Shortt

et al. 2009

Purpose Intramedullary (IM) nailing and plating are recognised fixation methods for both-bone midshaft forearm fractures. Although both methods are effective, IM nailing has recently been the accepted operative treatment for the paediatric population. The aim of the study was to compare the differences in the radiographic and functional outcomes of an age-and sex-matched cohort of children following treatment by IM fixation or plate fixation with screws for an unstable both-bone diaphyseal fracture. Methods A retrospective study was conducted and 17 age-and sex-matched pairs of patients returned for a research review clinic. The average age of our patients was 11.6 years at follow up, with 11 boys and six girls in each group. The mean follow up was similar in both groups (IM 31.5 months, plating 31.8 months). Results Plating and IM nailing result in good or excellent functional and radiological outcomes. Radiographs at the review clinic showed complete healing in the plating group, with reconstitution of the radial bow. Three patients in the IM group did not regain the natural radial bow radiographically. There were no significant differences between both groups for maximum radial bow and its location (P [ 0.05). However, the maximum radial bow was significantly different from normative values in both groups (P = 0.003 plate, P = 0.005 IM). No non-union or malunion was observed. There were no significant differences in the loss of forearm motion and grip strength between both groups. There was no difference in the Pediatric Orthopaedic Society of North America (POSNA) scores between both groups. The plating group had a significantly worse Manchester scar score than the IM group (P = 0.012). One major complication was observed in each group: osteomyelitis for IM fixation and ulnar never palsy for plating. Conclusion Our study suggests that functional outcome is likely to be equivalent, regardless of which method of internal fixation is used.