[Osteosynthesis in proximal forearm fractures in children].

OBJECTIVE: Closed reduction and fixation of displaced proximal radial neck or ulnar fractures with elastic stable intramedullary nailing (ESIN); prevention of circulatory disturbances and functional deficits following open reduction. INDICATIONS: Proximal radial neck fractures > 45 degrees displacement (< 10 years of age) or > 20 degrees (> 10 years of age); proximal extraarticular ulnar fractures > 10 degrees malalignment; combination injuries (Monteggia fracture, Monteggia-equivalent injury). CONTRAINDICATIONS: Minimally displaced or undisplaced fractures. SURGICAL TECHNIQUE: Radius: distal implantation of the nail; touching and fixation of the proximal fragment with the tip of the nail, if need be following digital or percutaneous partial reduction (Kirschner wire); definitive reduction by torsion of the nail. Ulna: distal implantation of a prebent nail; the prebent curve is placed opposite to the malalignment. POSTOPERATIVE MANAGEMENT: Functional treatment, no additive immobilization, no physical therapy.
RESULTS: 78-87% very good and good functional results.