Intramedullary nailing of adult forearm fractures: Results and complications

Blažević, Dejan; Benčić, Ivan; Ćuti, Tomislav; Bakota, Bore; Dobrić, Ivan; Sabalić, Srećko; Vidović, Dinko

doi:10.1016/j.injury.2020.11.012

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Problems such as large skin incisions, impaired blood supply, risk of soft tissue and periosteal injury, interruption of periosteal circulation due to the contact pressure of the plate, skin irritation from the implants, refracture after plate removal, and drainage of the fracture hematoma can lead to delayed union, nonunion, and infection. 7 - 11 In 1913, a study on fracture fixation with K-wires and Steinmann nails (first generation) was conducted. However, it showed high nonunion rates due to rotational instability.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the clinical and radiographic outcomes of plate fixation versus new-generation locked intramedullary nail in the management of adult forearm diaphyseal fractures

Polat¹,

Toy²

2022

AOTT

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Objective: This study aimed to compare functional and radiographical outcomes following intramedullary nailing (IMN) versus plate and screw osteosynthesis in managing patients with diaphyseal forearm fractures. Methods: Forty-six patients (27 male, 19 female) were included in this retrospective study. Of these, 25 were treated with plate osteosynthesis and 21 with IMN. The mean age was 32.4 (range, 19–67) years in the plate group and 28.8 (range, 18–64) years in the IMN group. The mean follow-up was 22.3 (range, 12–36) months in the IMN group and 24.8 (range, 12–48) months in the plate group. Functional outcomes were evaluated based on the forearm pronation/supination range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Grace-Eversmann scoring criteria. Results: The median time to union was 13.6 weeks in the plate group and 10.9 weeks in the IMN group (p<0.05). Union was achieved in 24 of 25 patients in the plate group (96%) and all patients in the IMN group (100%). The mean operative time was 69.7 (range, 45–110) minutes in the IMN group and 88.2 (range, 50–130) minutes in the plate group. The mean fluoroscopy time was 2.7 seconds in the plate group and 21.3 seconds in the IMN group. The mean length of hospital stay was five (range, 3–9) days in the plate group and four (range, 3–10) days in the IMN group. The mean operative time was significantly shorter in the IMN group (p < 0.05), while the mean fluoroscopy time was longer in the IMN group (p < 0.05). There was no significant difference between the groups in forearm pronation and supination, grip strength, DASH score, and Grace-Eversmann scoring criteria. Conclusion: Locked IMNs seem a viable alternative to ORIF with plate osteosynthesis for adult diaphyseal forearm fractures with similar healing rates, functional scores, and shorter operative times. Level of Evidence: Level III, Therapeutic Study

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Section: Introductionmentioning

confidence: 99%

Comparison of the clinical and radiographic outcomes of plate fixation versus new-generation locked intramedullary nail in the management of adult forearm diaphyseal fractures

Polat¹,

Toy²

2022

AOTT

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“…Notably, 11 instances of EPL ruptures were linked to IMN, necessitating reoperations for extensor pollicis longus reconstructions and tendon transfers, primarily diagnosed 2–6 weeks post-surgery. These injuries were often traced back to an ulnar entry point violating the third extensor compartment and creating bony spurs from Lister’s tubercle [ 12 , 18 , 28 ]. Thus, proper visualization, a more radial entry point, and hardware that is not prominent may mitigate this risk [ 12 , 17 , 18 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…These injuries were often traced back to an ulnar entry point violating the third extensor compartment and creating bony spurs from Lister’s tubercle [ 12 , 18 , 28 ]. Thus, proper visualization, a more radial entry point, and hardware that is not prominent may mitigate this risk [ 12 , 17 , 18 , 28 ]. Nerve palsies, impacting roughly 1% of IMN cases, were treated conservatively, though their precise cause remains elusive in most studies [ 10 , 14 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Interlocking intramedullary nail for forearm diaphyseal fractures in adults—A systematic review and meta-analysis of outcomes and complications

Lari,

Hassan,

Altammar

et al. 2024

J Orthop Traumatol

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Purpose The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. Methods Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. Results A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace–Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. Conclusions Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). Level of evidence III.

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“…Some studies have shown that the combination of radial plate fixation and ulnar intramedullary nail fixation proved to be a better method, which had good rotation stability and restored the radial arch effectively, and achieved satisfactory clinical results ( 20 ). Intramedullary nail fixation can shorten operation time and reduce surgical scar ( 21 ). However, it should be noted that the intramedullary nails used in abovementioned studies were straight interlocking intramedullary nails, which could not restore the radial arch or the rotation function of the forearm when fixing the radius.…”

Section: Discussionmentioning

confidence: 99%

Hybrid fixation with ESIN for both bone forearm fractures in adults: A case report and literature review

Bai

Liu²,

Chen³

et al. 2022

Front. Surg.

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ObjectiveBoth bone forearm fractures are common in children and rare in adults. The main surgical treatment is open reduction and internal fixation (ORIF) with plate, while the hybrid fixation of elastic-stable intramedullary nailing (ESIN) and the plate has been rarely reported before.Case reportWe report a case of a 29-year-old male patient with both bone forearm fractures. Temporarily closed reduction and plaster external fixation were performed in the emergency room, and the patient was admitted to the orthopedic trauma ward for surgery. The patient underwent open reduction and plate fixation of the ulna and closed reduction and ESIN fixation of the radius. The fractures healing was satisfactory and the internal fixation was removed 12 months postoperatively.ConclusionThe hybrid fixation of ESIN and plate is an effective option for both bone forearm fractures in adults.

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Intramedullary nailing of adult forearm fractures: Results and complications

Cited by 8 publications

References 24 publications

Comparison of the clinical and radiographic outcomes of plate fixation versus new-generation locked intramedullary nail in the management of adult forearm diaphyseal fractures

Comparison of the clinical and radiographic outcomes of plate fixation versus new-generation locked intramedullary nail in the management of adult forearm diaphyseal fractures

Interlocking intramedullary nail for forearm diaphyseal fractures in adults—A systematic review and meta-analysis of outcomes and complications

Hybrid fixation with ESIN for both bone forearm fractures in adults: A case report and literature review

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