Evaluation of the functional results of intramedullary nailing in diaphyseal both bone forearm fractures in children

Abstract

Purpose: To evaluate the functional results of intramedullary nailing in diaphyseal both bone forearm fractures in children. Patients and Methods: 40 patients (30 males and 10 females) with an age group of 8-14 years were included in the study. Displaced diaphyseal fractures, fractures with loss of reduction (within first week) in casting, segmental fractures, and open fractures (Gustilo & Anderson type 1 & 2) were considered for intramedullary fixation. The fractures were reduced percutaneously by manipulating the fracture fragments & were stabilised by 2-2.5 mm flexible titanium intramedullary nails. Retrograde nailing of radius was done from the dorsal entrance site. Antegrade nailing of ulna was done from the lateral cortex of the olecranon. Patients were followed at two weeks, four weeks, six weeks, eight weeks and then at monthly intervals up to 9 months. Final follow up was done at 9 months and results were assessed clinically using Daruwalla criteria with restoration of forearm rotation. Results: In 31 (77.5%) cases, closed reduction and nailing was achieved using 2 to 2.5 mm flexible titanium nails while in 9 (22.5%) cases open reduction through limited incisions was done. In all patients fracture was united at an average of 8.1 weeks. In all patients, removal of implant was done at 6 months. Excellent results were in seen 38 (95%) patients & good results in 02 (5%) patients using Daruwalla criteria with restoration of forearm rotation. The complication reported were bursa formation in 7 (17.5%) patients, symptomatic prominent hardware in 5 (12.5%) patients, superficial radial nerve injury in 1 patient, wound related problems in 3 patients & refracture in 1 patient. Conclusion: Elastic intramedullary nailing is a safe and reliable method for internal fixation of displaced diaphyseal unstable forearm fractures with good to excellent functional results.