Elastic intramedullary nailing as treatment for bioseous forearm fractures in pediatric patients

Abstract

INTRODUCTION: Forearm fractures are the most common long bone fractures in children, accounting for
approximately 40% of all pediatric fractures. Although forearm bone fractures can be managed
conservatively in most cases, results remain variable and later some cases may require additional fracture
manipulation or formal surgery due to residual angulations. Previous studies have shown that the failure of
non-surgical treatment of mid-axis fractures in pediatric populations ranges from 39% to 64%. Alternatives
include closed remanipulation and reduction, pins and plaster, closed or minimally invasive reduction,
elastic endomedullary nailing (EEE), and open reduction and internal fixation (ORIF) with plates and
screws.
OBJECTIVE: To evaluate radiological and functional results, as well as complications associated with
forearm bone fractures treated with titanium elastic nails in children.
MATERIAL AND METHODS: Observational, retrospective, descriptive study. A series of pediatric
patients with a diagnosis of displaced forearm fracture treated by EEE was evaluated. The universally
known AO classification was used to classify the fractures, and the Gustilo classification for open fractures.
A follow-up was carried out at two, four, eight, 12 and 24 weeks after the intervention until the extraction
of the osteosynthesis material. A functional evaluation was obtained based on the Mayo Elbow Performance
Score and early or late complications were described based on the Claviel-Dindo scale for forearm fractures.
Radiographs were analyzed to determine the time to union, loss of correction, and angle deformities> 10 °
at the time of union.
RESULTS: Of 30 patients, 28 presented closed fractures while 2 presented exposed fractures, all Gustilo I.
According to the AO classification, 21 22A3 fractures and 9 22B3 fractures were found. The mean time to
fracture healing was a mean of 8.38 weeks (SD 3.01). In accordance with the Mayo Elbow Performance
Score, excellent results were obtained in 28 patients, and good results in 2. Of the 30 patients, 3 presented
complications according to the Claviel-Dindo scale: one grade I complication (delayed union), one
complication of grade II (superficial infection) and one of grade III (early removal due to infection
associated with intolerance of materials). No angular deformities, no nonunion rates or significant loss of
correction were observed.
CONCLUSIONS: Elastic intramedullary nailing is a versatile and efficient option in the reduction and
fixation of unstable forearm fractures of both bones in children. It allows rapid mobilization and
consolidation, has very good functional results, and the complication rate is low.