Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children

Abstract

Since its introduction by Metaizeau and Prevot, elastic-stable intramedullary nailing (ESIN) has been used for almost all diaphyseal fractures in children. Here, we present a retrospective study analyzing the long-term results of ESIN of forearm fractures in children.A total of 122 patients with diaphyseal forearm fractures and single subtypes in childhood were treated from 2000 to 2007 at our University Hospital by ESIN. At follow-up, the current conditions of the patients were evaluated using the Disabilities of Arm, Shoulder, and Hand (DASH) Score, and the Mayo Wrist score. Moreover, an individual questionnaire with 16 items was used to collect further information about the patient's condition and limitations as adults.The evaluation was performed at 12.4 years (average) after surgery. In our study population (n = 90), the average DASH scores for sports, performing arts, and work were 0.4 (standard deviation: 1.45), 0.9 (standard deviation: 5.68), and 0.3 (standard deviation: 7.39), respectively. Furthermore, 77% of our patients achieved a DASH Score of 0 (optimum outcome). The average Mayo Wrist Score was 97.64 (standard deviation: 7.39), and 82% of the study population achieved a score of 100 (optimum outcome). A correlation between the DASH and Mayo Wrist Scores was found in few patients. Overall, the DASH Score, Mayo Wrist Score, and results of our individual questionnaire demonstrated convincing point values.This study demonstrated favorable long-term results achieved by ESIN of forearm fractures in children. It seems that good outcomes, reported by various studies with short- to mid-term follow-up beforehand, do not deteriorate over time.Level of Evidence: Level III; retrospective study; therapeutic study.

Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

“…This is the standard of care in many hospitals around the world [3,5,19,20]. Furthermore, modifications to the intramedullary nailing technique were introduced by several authors: Some of the authors routinely use a single nail stabilizing both the forearm bones, with comparable results to using the classic two nail insertion technique, or recommend careful consideration when choosing the surgical technique and materials for fracture stabilization [18,23]. On the other hand, when trying to reduce the cost, the entire picture, and not only the cost generated by the inpatient treatment, has to be considered.…”

Carta ao editor sobre o artigo: Fixação intramedular flexível para fraturas diafisárias dos ossos do antebraço em crianças

“…On the other hand, the article by Peterlein et al 4 provides important information to apply in all patients who undergo this type of surgery, because it focus on evaluating the long-term results of flexible intramedullary nailing in diaphyseal fractures of forearm in a total of 122 children. Patients were evaluated with the Arm, Shoulder and Hand Disabilities (DASH) scale and the Mayo Wrist score.…”

“…Por outro lado, o artigo de Peterlein et al 4 fornece informações importantes para serem aplicadas em todos os pacientes submetidos a esse tipo de cirurgia, pois se concentra em avaliar os resultados a longo prazo da haste intramedular flexível nas fraturas diafisárias de antebraço em um total de 122 crianças. Os pacientes foram avaliados com a escala de deficiências no braço, ombro e mão (DASH, na sigla em inglês) e com a escala de Mayo Wrist.…”

Resposta à carta ao editor referente ao artigo: Fixaçço intramedular flexível para fraturas diafisárias dos ossos do antebraço em crianças

“… 4 Peterlein et al reported good long-term results of pediatric forearm fractures treated with IM nailing. 5 Martus et al concluded that IM nailing is an effective technique for pediatric forearm fractures with good to excellent outcomes in 91%. 6 …”

“… 4 Peterlein et al relataram bons resultados em longo prazo de fraturas no antebraço pediátrico tratadas com haste intramedular. 5 Martus et al concluíram que a técnica de procedimento com a haste intramedular é eficaz para fraturas no antebraço pediátrico com resultados bons ou excelentes em 91% dos casos. 6 …”