Treatment of forearm fractures in children and adolescents with titanium elastic nails (Tens): A prospective study

Abstract

Paediatric forearm fractures are generally treated nonoperatively by close reduction and casting. Recently there has been trend on intramedullary nailing of diaphyseal forearm fractures for unstable fracture pattern to impove clinical outcomes. In our study we evaluated the rate of fracture union, functional outcome and complications in forearm fractures of children and adolescents treated with titanium elastic intramedullary nails. All cases achieved union within 16 weeks and excellent functional outcome after surgical management without significant complications. Intramedullary nailing with Titanium elastic nails is a feasible and effective method of treatment for unstable diaphyseal fractures of forearm in children and adolescents. Introduction Fractures of the both bones forearm are very common orthopaedics injuries in the pediatric age group. Forearm fractures comprises 40% or more of paediatric fractures [1]. The mechanism of injury mostly involves a fall onto an outstretched hand. Majority of the fractures are usually treated conservatively with plaster casting. For displaced and unstable forearm fracture where closed reduction cannot be achieved, surgical intervention is indicated like rigid plate fixation and elastic intramedullary nails. Recently, however, there has been a trend towards increased surgical management of these fractures in an effort to improve clinical outcomes [2]. Elastic intramedullary nails were originally developed in the early 1980s by surgeons in Nancy, France [3, 4]. There has been an increased interest in determining which method provides superior results, but the optimal treatment remains controversial [5]. Forearm fracture fixation with flexible nails has gained popularity, with proponents arguing that nailing results in decreased surgical dissection and retention of biologic factors at the fracture site [6, 7]. Both titanium and stainless steel flexible nails are available. In the clinical setting, titanium (Ti 6A114V) is being used more often than stainless steel in most circumstances because of the elastic properties which allow for improved insertion and rotation while still providing adequate fracture stabilization [8] .