OBJECTIVE: Fracture stabilization and restoration of bony anatomy with elastic stable intramedullary nailing (ESIN). INDICATIONS: Diaphyseal forearm fractures with displacements > 10 degrees . In cases of narrowing of the marrow cavity functional deficits can be encountered even in displacements < 10 degrees . CONTRAINDICATIONS: Distal metaphyseal fractures. Undislocated unstable fractures with no need for repositioning. Grade III open fractures. Greenstick fractures in patients < 5 years. SURGICAL TECHNIQUE: After skin incision 2 cm proximal to the distal radial epiphysis, the cortical bone is transfixed diagonally toward proximal (ascending). The ulnar bone is transfixed from proximal to distal (descending). For that, a small incision 2 cm distal to the olecranon apophysis is made. To reduce the risk of refractures in case of greenstick fractures at the forearm, bones should be broken completely after introduction of the wires. Furthermore, implant removal is recommended approximately 6-8 months postoperatively. POSTOPERATIVE MANAGEMENT: No additional fixation is required, allowing immediate functional treatment with early return to school. RESULTS: Operative treatment of forearm shaft fractures with ESIN was analyzed in 77 children. Average duration of surgery was 44 min (10-140 min). After an average of 7 months (1-13 months), the nails were removed. Postoperative complications were analyzed in 74 patients (96%). In three patients (4%), a superficial pin site infection emerged. One child (1%) fell on his arm again and broke his distal radius during ESIN treatment, and one patient (1%) showed deflected nails after a refall on the arm 1 week after surgery. Assessment of functional outcome in 70 patients revealed only two cases (3%) with minimal functional deficit.
OBJECTIVE: Fracture stabilization and restoration of bony anatomy with elastic stable intramedullary nailing (ESIN). INDICATIONS: Diaphyseal forearm fractures with displacements > 10 degrees . In cases of narrowing of the marrow cavity functional deficits can be encountered even in displacements < 10 degrees . CONTRAINDICATIONS: Distal metaphyseal fractures. Undislocated unstable fractures with no need for repositioning. Grade III open fractures. Greenstick fractures in patients < 5 years. SURGICAL TECHNIQUE: After skin incision 2 cm proximal to the distal radial epiphysis, the cortical bone is transfixed diagonally toward proximal (ascending). The ulnar bone is transfixed from proximal to distal (descending). For that, a small incision 2 cm distal to the olecranon apophysis is made. To reduce the risk of refractures in case of greenstick fractures at the forearm, bones should be broken completely after introduction of the wires. Furthermore, implant removal is recommended approximately 6-8 months postoperatively. POSTOPERATIVE MANAGEMENT: No additional fixation is required, allowing immediate functional treatment with early return to school. RESULTS: Operative treatment of forearm shaft fractures with ESIN was analyzed in 77 children. Average duration of surgery was 44 min (10-140 min). After an average of 7 months (1-13 months), the nails were removed. Postoperative complications were analyzed in 74 patients (96%). In three patients (4%), a superficial pin site infection emerged. One child (1%) fell on his arm again and broke his distal radius during ESIN treatment, and one patient (1%) showed deflected nails after a refall on the arm 1 week after surgery. Assessment of functional outcome in 70 patients revealed only two cases (3%) with minimal functional deficit.
Authors: Brian A Kelly; Benjamin J Shore; Donald S Bae; Daniel J Hedequist; Michael P Glotzbecker Journal: J Child Orthop Date: 2016-06-08 Impact factor: 1.548