Pearls and Pitfalls of Forearm Nailing

Abstract

Pediatric forearm fractures are one of the most common injuries that pediatric orthopaedic surgeons manage. Unstable fractures that have failed closed reduction and casting require surgical intervention in order to correct length, alignment, and rotation to optimize forearm range of motion and function. Flexible intramedullary nailing (FIN) is a powerful technique that has garnered widespread popularity and adaptation for this purpose. Surgeons must become familiar with the technical pearls and pitfalls associated with this technique in an effort to prevent complications. Key Concepts: • Flexible intramedullary nailing is a useful technique that is widely utilized for most unstable both-bone forearm fractures except in the setting of highly comminuted fracture patterns or in refractures with abundant intramedullary callus formation. • Proper contouring of the rod prior to insertion and bending of the tip will help decrease the risk of malunion and facilitate rod passage across the fracture site. • The surgeon must be aware of the numerous pitfalls that are associated with flexible intramedullary nailing and the methods to mitigate each complication.