Refractures of the paediatric forearm with the intramedullary nail in situ

Abstract

Forearm fractures in children are common. When conservative treatment fails, internal fixation with Elastic Stable Intramedullary Nailing (ESIN) become the first choice in the operative treatment of diaphyseal forearm shaft fractures. Refractures with the intramedullary nail in situ are known to occur but formal guidelines to guide management in such fractures are lacking. We present a well-documented case of a radius midshaft refracture in a 12-year-old boy with the intramedullary nail in situ, managed by closed reduction. Literature is reviewed for this type of complication, the treatment of 30 similar cases is discussed and a treatment strategy is defined.The refracture of the paediatric forearm fracture with the intramedullary nail in situ is a rare, but probably under recognised complication which is observed in approximately 2.3% of the study population. Closed reduction may be considered in these cases.

Pediatric Forearm Refracture with Intramedullary Nail Bending In Situ: Options for Treatment

“…In cases of refractures of forearm fractures with intramedullary nails in situ that are reported in the literature, most of the patients were treated with closed reduction and nail replacement [11,13,14]. But some patients were treated with closed reduction leaving nails in situ, and applying plaster if a reduction was acceptable [6,12]. We had permission to try closed reduction first and, if acceptable reduction could not be reached, nail exchange could be used.…”

“…Internal fixation with elastic intramedullary nailing has become the treatment option of choice for forearm fractures in children [4,5]. The incidence of refractures of forearm fractures with an intramedullary nail in situ is very rare, and there are no formal guidelines for the management of these fractures [6].…”

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“…Актуальность: Переломы костей предплечья у детей являются в детской травматологии одними из наиболее часто встречающихся переломов и составляют до 43,6%. Несмотря на разработку целого ряда новых систем и направлений в лечении повреждений костей предплечья число осложнений в виде повторных переломов остается довольно высоким и достигает от 4% до 21,3% [1,2,5,6,11,15,18,19]. Несмотря на достижения медицинской науки в области детской травматологии и ортопедии, исследования, посвященные лечению рефрактур, единичны [3,7,12].…”

Morphological features of bone regeneration in simulated refracture of growing long bones

“…The gold standard surgical tool for pediatric fractures requiring fixation is elastic stable intramedullary nailing (ESIn) [4][5][6]. Delayed consolidation and nonunion are reported in 0.5-3.2 % of the cases, whereas refractures after ESIN occur in 4.9-6.7 % of children [7][8][9][10]. Pediatric refractures are reported to range between 4 % and 21.3 % [11][12][13][14].…”