Short, double elastic nailing of severely displaced distal pediatric radial fractures

Abstract

Rationale:Short double elastic nailing is a minimal invasive, modified ESIN (elastic stable intramedullary nailing) technique for severely displaced distal radial fracture in children. The aim of this technical report is to introduce our new method and evaluate the final results of the procedure.Patient concerns:We reviewed retrospectively 24 patients who underwent short double elastic nailing due to distal radial fractures between November 2012 and December 2015. Indications for surgery included closed, severely displaced, unstable metaphyseal or diametaphyseal fractures of the radius.Intervention:The fractures were stabilized by 2 prebent short elastic titanium nails inserted from the distal side of the fracture. In cases of associated ulnar fracture, a classic anterograd ESIN nailing was also performed. Patients were mobilized immediately in a removable short splint which was removed after 1 to 2 weeks. There has been no additional splinting or casting.Outcomes:There were 17 males and 7 females with an average age of 9.8 years (range, 4–16 years). The right hand was involved in 16 cases and the left hand in 8 cases. The average follow-up was 17.8 months (range, 7–28 months). Of the 24 patients, 3 presented irritation of the skin, which resolved after removal of the radial nail. All the patients regained full range of motion without any complications.Lessons:Our technique is an effective, safe, and easily learnable procedure for unstable fractures of the distal third of the radius. It achieves good functional and radiological results, and allows early mobilization without the need of casting. Avoiding the physeal plates, we reduce the risk of iatrogenic postoperative deformity. Further prospective and biomechanical investigations are necessary to verify our experience.

Antegrade elastic stable intramedullary nail fixation for paediatric distal radius diaphyseal metaphyseal junction fractures: A new operative approach

“…There are only a few reports on these fractures [4][5][6][7]. Reduction and surgical immobilisation for paediatric DRDMJ fractures remain a challenge [6,7]. Many surgical immobilisation techniques have been reported, but each type of fixation has limitations.…”

“…However, paediatric fractures in the area of the distal radius diaphyseal metaphyseal junction (DRDMJ) represent a unique problem, namely, they are usually located too distally to be treated by classic ESIN fixation and too proximal for conventional K-wires fixation [3,4]. The treatment of paediatric DRDMJ fractures is a challenge, as evidenced by the numerous surgical techniques described, including conventional methods (crossed K-wires, open reduction and plate fixation and conventional ESIN fixation) and modified techniques (transepiphyseal intramedullary Kirschner wire fixation, pre-bending intramedullary nailing fixation, and short, double elastic nailing fixation) [4][5][6][7].…”

Fixation of unstable distal radius fractures by using expandable Intramedullary nailing system in adult patients

“…Although various types of intramedullary nailling devices, such as Targon DR and Micro nail have been used for fixation of unstable fractures of the radius and reported to be associated with satisfactory results. 8 , 9 , 22 , 23 experience and studies on Sonoma Wrx are limited. 24 , 25 In our previous prospective randomized pilot study, we compared standard volar locking plate with intramedullary fixation using the Sonoma Wrx, and found that clinical and radiological outcome of two techniques were comparable and satisfactory in treatment of distal radius fractures.…”

“…Intramedullary nailing has been introduced as a less invasive technique for internal fixation of both intra- and extra-articular distal radius fractures and for correction of post-traumatic deformity. 7 - 9 With the advantages of minimum soft-tissue dissection, intramedullary nailing promotes effective fracture stabilization and healing. 10 Clinical studies showed that in comparison to volar plating, intramedullary nailing provides better or comparable early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome, a major complication of distal radius fracture.…”

“…Several devices for intramedullary nailing have been on the market, which showed promising outcomes for internal fixation of distal radius fractures. 9 , 13 , 14 However, there are limited studies reporting the outcome of intramedullary nailing device Sonoma Wrx (Sonoma Orthopedic Products Inc., Santa Rosa, CA, USA), which has an expandable shaft that becomes rigid once implanted. 15…”