Elastic intramedullary nail treatment of adolescent perihardware radius and ulna refracture

A 13-year-old girl presented to the clinic with a midshaft refracture of both forearm bones adjacent to the site of a prior forearm fracture that had been treated with plating. She was treated with hardware removal and placement of elastic intramedullary nails. Flexible intramedullary nailing can be successful for a skeletally mature adolescent in treatment of refracture surrounding plate fixation of a midshaft forearm fracture. This technique allows for additional protection of the entire length of the affected bones, while avoiding the extensive dissection needed for extended plating.

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Elastic stable intramedullary nailing in pediatric diaphyseal forearm bone fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170455 ◽

2017 ◽

Vol 3 (2) ◽

pp. 190

Author(s):

Poojan Kumar Rokaya ◽

Mangal Rawal ◽

Javed Ahmad Khan ◽

Praveen Kumar Giri

Keyword(s):

Intramedullary Nailing ◽

Bone Fracture ◽

Closed Reduction ◽

Forearm Fracture ◽

Minimal Invasive ◽

Elastic Stable Intramedullary Nailing ◽

Forearm Bones ◽

Average Loss ◽

Forearm Bone ◽

Elastic Intramedullary Nailing

Background: Pediatric forearm bone fracture present significant challenges where most of them are managed with closed reduction and casting. Irreducible, unstable and open fracture usually requires operative stabilization. Intramedullary nailing is considered minimal invasive however it is not free of complication. The aim of this study is to analyze the outcome and complications after elastic stable intramedullary nailing in pediatric diaphyseal forearm fracture.Methods: A descriptive observational study was carried out for four years (2013-2016) in diaphyseal pediatric forearm fracture stabilized with titanium elastic stable intramedullary nailing. Final range of motion, complications and outcome were assessed using Clavien-Dindo classification modification appropriate for orthopedic surgery.Results: We report the outcome of 36 patients with complete medical records. Closed reduction and nailing was successful in 25 patients (69.4%) whereas eleven patients (30.6%) required open reduction (both radius and ulna in 6 patients 16.7%, ulna in 3 patients 8.3% and radius in 2 patients 5.6%). Radiological union was achieved at an average of 7.75±1.5 weeks (range 6 to 16 weeks). Forearm rotation was limited in 7 patients with average loss of 16° pronation and 18° supination. The overall rate of complication was 22.2%. According to Clavien-Dindo classification excellent results were noted in 29 patients (80.6%), good in 3 patients (8.3%) and fair in 4 patients (11.1%). Conclusions: Elastic intramedullary nailing in pediatric diaphyseal forearm bones fracture is minimally invasive with low rate of complication and the outcomes are fair to excellent.

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Intramedullary Nailing of Paediatric Tibial Fractures: Comparison between Flexible and Rigid Nails

Scandinavian Journal of Surgery ◽

10.1177/1457496920958620 ◽

2020 ◽

pp. 145749692095862

Author(s):

S. Widbom-Kolhanen ◽

I. Helenius

Keyword(s):

Intramedullary Nailing ◽

Intramedullary Nail ◽

Patient Characteristics ◽

Tibial Fractures ◽

University Hospital ◽

Elastic Stable Intramedullary Nail ◽

Flexible Intramedullary Nailing ◽

Several Variables ◽

Elastic Intramedullary Nailing

Purpose: To describe patient characteristics and to compare outcomes of children undergoing rigid intramedullary nailing of tibial fractures as compared with those operated on using elastic intramedullary nailing. Methods: A retrospective review of 26 children who have undergone flexible intramedullary nailing of tibial fractures and 30 children with rigid nailing at our university hospital between 2008 and 2017. The patient charts and radiographs were evaluated to identify demographic characteristics and several variables were measured preoperatively, as well as 6–12 weeks postoperatively in addition to final follow-up radiographs. Results: Twenty-six patients (26/26, 100%) treated with a flexible nail and 14 patients (14/30, 46.7%) treated with a rigid nail had open proximal tibial physis (p < 0.001). An acceptable postoperative alignment was obtained in 20 patients (20/26, 76.9%) in the elastic stable intramedullary nail group and in 29 patients (29/30, 96.7%) in the rigid group (p = 0.026). Some complications occurred in four patients (4/26, 15%) in the elastic stable intramedullary nail population and seven patients (7/30, 23%) in the rigid intramedullary nail population (p = 0.46). Malunion occurred in six patients (6/26, 23%) in the elastic stable intramedullary nail group and in none of the patients treated with a rigid intramedullary nail (p = 0.005). Conclusion: Younger children with tibial fractures who weight 50 kg or less and with proximal tibial growth plates wide open can be treated with elastic stable intramedullary nail while more mature adolescents benefit from rigid intramedullary nailing.

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Functional Outcome of Displaced Diaphyseal Both Bone Forearm Fracture in Children Treated with Elastic Stable Intramedullary Nails

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24878 ◽

2018 ◽

Vol 16 (2) ◽

pp. 47-49

Author(s):

Gopal Sagar DC

Keyword(s):

Functional Outcome ◽

Intramedullary Nail ◽

Forearm Fracture ◽

Diaphyseal Fracture ◽

Intramedullary Nails ◽

College Hospital ◽

Average Hospital ◽

Elastic Stable Intramedullary Nail ◽

Minimal Morbidity ◽

Day Range

Introduction: Pediatric forearm fractures are most commonly managed by closed reduction and above elbow cast. Failure to achieve anatomical initial reduction, tight cast and re-displacement within cast leading to malunion are common complication. Elastic stableintramedullary nailing for such fracture gives more predictable result with minimal morbidity. We studied on functional outcome of such fracture treated operatively with elastic stable intramedullary nail in our center. Methods: This prospective descriptive study was done in Nepalgunj Medical College Hospital, Nepalgunj between January 2015 to May 2017.It included 47 pediatric patients (5-15 years) with displaced both bone forearm diaphyseal fracture. All fractures were fixed with elastic stable intramedullary nails of appropriate size under general anesthesia. Cases were followed up at 1, 2, 4, 6, 8, 10, 12 weeks and at 6 month functional outcome was evaluated using price criteria. Data were entered in structured proforma and statistical analysis was carried out using SPSS 20.0. Results: Out of 47 cases included in our study, mean age of patient was 9.7 years (range 5-15 years). 31(65.9%) cases were male and16 (34.1%) were female. 42(89.4%) cases had closed fracture and 5(10.6%) had grade I open factor. 40(85.1%) cases were operated by closed technique. Average hospital stay was 2.7±1.8 day (range 2-5days). Radiological union was achieved on 6.5±2.7 weeks (range 6-11weeks).Functional outcome in final follow up at 6 month was excellent in 36(76.6%), good in 9(19.1%) and fair in 2(4.3%) cases. Superficial surgical site infection was seen in 3 cases (6.3%) and exposure of nail tip was seen in 2 cases (4.2%). Conclusion: Elastics table intramedullary nail for displaced pediatric both bone forearm diaphyseal fracture is biological osteosynthesis, simple and reproducible treatment with excellent functional outcome with minimal morbidity.

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Repair of an open forearm fracture and extensive bony loss (case report)

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-1-87-91 ◽

2021 ◽

Vol 27 (1) ◽

pp. 87-91

Author(s):

Sh.M. Davirov ◽

◽

P.U. Urinboev ◽

Keyword(s):

High Risk ◽

Intramedullary Nailing ◽

Forearm Fracture ◽

Complete Recovery ◽

Bony Defect ◽

Fibular Graft ◽

Comminuted Fracture ◽

Soft Tissue Necrosis ◽

Ilizarov Frame ◽

Forearm Bones

Introduction Repair of a double open comminuted fracture of forearm bones with extensive bony loss is challenging due to a high risk of infection and the need to address a significant bony defect. Neither internal fixation nor open reduction could be considered due to substantial bone loss and severely impaired circulation with a high risk of soft tissue necrosis and infection. We report staged management of forearm fracture using avascular autologous graft to repair the defect and maintain the forearm length. Objective Demonstrate the successful management of the double open comminuted fracture of forearm bones with extensive bony loss using Ilizarov external fixation, classical autologous grafting harvested from fibula and intramedullary (IM) nailing. Results and discussion The limb was temporarily fixed with Ilizarov frame in an extra-focal manner. An autogenous fibular graft of 11 cm was used to fill in the gap. Intramedullary nailing of the radius and ulna was produced and ulnar defect was repaired with autogenous fibular graft. IM nails were removed once the bones consolidated. The limb function was completely regained, anatomical length of the segment maintained and metal constructs removed. Conclusion Combination of different bone fixation modalities, classical autografting technique and intramedullary nailing provided complete recovery of the broken limb maintaining the function and bringing down the risk of complications to ensure a good clinical result.

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EARLY OUTCOMES OF FLEXIBLE INTRAMEDULLARY NAILING IN PEDIATRIC SHAFT OF FEMUR FRACTURES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i6.6137 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2157-60

Author(s):

Muhammad Umair Hashmi ◽

Muhammad Nadeem Ahsan ◽

Babar Bakht Chughtai ◽

Saqib Majeed

Keyword(s):

Intramedullary Nailing ◽

Intramedullary Nail ◽

Femur Fracture ◽

Fracture Site ◽

Medullary Canal ◽

Femur Fractures ◽

Flexible Intramedullary Nailing ◽

Mean Diameter ◽

Flexible Intramedullary Nail ◽

Age Range

Objective: To study the early outcomes and complications of fixation of pediatric shaft of femur fractures using flexible intramedullary nail. Study Design: Prospective observational study. Place and Duration of Study: Orthopedic Department, Bahawal Victoria Hospital Bahawalpur, from Jan to Jun 2021. Methodology: Children between the ages of 5-11 years with shaft of femur fractures were included in the study. Fixation of fracture was done using elastic intramedullary nail. Final outcomes of fixation were observed using Flynn and Schwend Scoring System. Six-month follow-up was done in all cases. Data was analyzed using SPSS-20. Results: Total 70 cases having shaft of femur fracture were included in the study. Age range of cases was 5-11 years with mean age of 7.75 ± 1.66 years and mean weight of 24.44 ± 4.77 kilograms. Mean diameter of femur medullary canal was 7.48 ± 0.63 millimeters and mean diameter of flexible nail was 3.03 ± 0.26 millimeters. Mean post-operative period of radiological union of fracture was 8.57 ± 1.05 weeks. Per-operatively, fracture site was approached in 4 (5.7%) cases. Migration of nail was not seen in any case. Final outcomes according to Flynn and Shwend Score were excellent in 62 (88.5%), satisfactory in 7 (10%) and poor in 1 (1.4%) case. Conclusion: Fixation of shaft of femur fracture using flexible intramedullary nailing technique is safe and reliable with good outcomes among children between 5-11 years of age.

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Casting versus flexible intramedullary nailing in displaced forearm shaft fractures in children aged 7–12 years: a study protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-048248 ◽

2021 ◽

Vol 11 (8) ◽

pp. e048248

Author(s):

Petra Grahn ◽

Juha-Jaakko Sinikumpu ◽

Yrjänä Nietosvaara ◽

Johanna Syvänen ◽

Anne Salonen ◽

...

Keyword(s):

Range Of Motion ◽

Intramedullary Nailing ◽

Closed Reduction ◽

Intramedullary Nails ◽

Cast Immobilisation ◽

Flexible Intramedullary Nailing ◽

Shaft Fractures ◽

Fractures In Children ◽

Flexible Intramedullary Nails

IntroductionThe forearm is the most common fracture location in children, with an increasing incidence. Displaced forearm shaft fractures have traditionally been treated with closed reduction and cast immobilisation. Diaphyseal fractures in children have poor remodelling capacity. Malunion can cause permanent cosmetic and functional disability. Internal fixation with flexible intramedullary nails has gained increasing popularity, without evidence of a better outcome compared with closed reduction and cast immobilisation.Method and analysisThis is a multicentre, randomised superiority trial comparing closed reduction and cast immobilisation to flexible intramedullary nails in children aged 7–12 years with >10° of angulation and/or >10 mm of shortening in displaced both bone forearm shaft fractures (AO-paediatric classification: 22D/2.1–5.2). A total of 78 patients with minimum 2 years of expected growth left are randomised in 1:1 ratio to either treatment group. The study has a parallel non-randomised patient preference arm. Both treatments are performed under general anaesthesia. In the cast group a long arm cast is applied for 6 weeks. The flexible intramedullary nail group is immobilised in a collar and cuff sling for 4 weeks. Data are collected at baseline and at each follow-up until 1 year.Primary outcome is (1) PROMIS paediatric upper extremity and (2) forearm pronation-supination range of motion at 1-year follow-up. Secondary outcomes are Quick DASH, Paediatric Pain Questionnaire, Cosmetic Visual Analogue Scale, wrist and elbow range of motion as well as any complications and costs of treatment.We hypothesise that flexible intramedullary nailing results in a superior outcome.Ethics and disseminationWe have received ethical board approval (number: 78/1801/2020) and permissions to conduct the study from all five participating university hospitals. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications.Trial registration numberNCT04664517.

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COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE & SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v2i6.38 ◽

2018 ◽

Author(s):

Anil Pandey ◽

Setul Shah ◽

Deepak S Maravi ◽

S Uikey

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Proximal Tibia ◽

Plate Fixation ◽

Surgical Site Infections ◽

Delayed Union ◽

Large Sample Size ◽

Multicentric Study ◽

Group A ◽

Group B

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

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Randomized Controlled Trial of the Clinical Recovery and Biodegradation of Polylactide-co-glycolide Implants Used in the Intramedullary Nailing of Children’s Forearm Shaft Fractures with at Least Four Years of Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm10050995 ◽

2021 ◽

Vol 10 (5) ◽

pp. 995

Author(s):

Marja Perhomaa ◽

Tytti Pokka ◽

Linda Korhonen ◽

Antti Kyrö ◽

Jaakko Niinimäki ◽

...

Keyword(s):

Intramedullary Nailing ◽

Controlled Trial ◽

Long Term Outcomes ◽

Intramedullary Nails ◽

Metal Implants ◽

Shaft Fractures ◽

Fractures In Children ◽

Significant Difference

The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN (n = 19) or ESIN (n = 16). Forearm rotation at minimally four years’ follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, n = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively.

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