A Critical Analysis of Postoperative Complications of Antebrachium Ten-Nailing in 35 Children

Abstract

Background: unstable antebrachium diaphyseal fractures in children are nowadays increasingly treated operatively by elastic intramedullary nailing.Aim: Aim of the study was to critically assess both radiological and functional outcome of antebrachium fractures treated by titanium elastic nail (ten) in a pediatric cohort.Material and Methods: this retrospective study investigated 75 consecutive children, who were treated for antebrachium shaft fractures at tampere university hospital during the time period from January 2001 to december 2005. All the fractures were classified according to otA. thirty-five children (mean age 12.3 years) were treated by ten-nailing. twenty four of the forearm fractures were instable, five were open, five were re-fractures and one had ulnar nerve deficit. in all but one patient both forearm bones were fractured. twelve (34%) operations were managed by closed reduction, open reduction was needed in 23 (66%) patients. in 29 cases both bones were fixed with ten-nail. in the four patients with re-fracture in both ulna and radius only the radius was ten-nailed. in one case radius was fixed with ten-nail and ulna with K-wire and in another case radius was fixed with ten-nail and ulna with plate. fracture pattern, mode of reduction, surgical approach, short-and long-term complications and outcome were recorded.Results: twenty three (66%) patients achieved healing of the fractures without any limitation in range of motion. twelve patients with postoperative complication were followed up 31-74 (median of 54) months. eleven (31%) patients had minor postoperative complications and one (0,3%) patient had a volkmann's ischemic contracture. five of complicated patients had more than one problem. immediate post-operative problems were noted in these five patients. At follow-up visits four patients complained of ulnar nail discomfort, two had neural symptoms. Additionally, three children suffered from re-fractures.Discussion: despite various minor complications, ten-nailing is considered suitable treatment for unstable forearm shaft fractures. most of the problems were related to poor technical performance in nailing.

Refractures of the paediatric forearm with the intramedullary nail in situ

“…Weinberg et al 14 reported one refracture (2.5%) without mentioning the treatment method. Salonen et al 18 describes three refractures of which one was treated with replacement of the nails and above elbow cast, one was treated conservatively but it remains unclear in which manner and the last was a patient with a bone fracture of which the plate osteosynthesis of the ulna had to be revised after a refracture as well as the intramedullary nail in the radius was replaced by plate osteosynthesis. Garg et al 15 treated their refracture, one of 21 (4.8%), with replacement of the intramedullary nail and above elbow plaster cast for 2–4 weeks.…”

Elastic Stable Intramedullary Nailing for Pediatric Forearm Fractures: A Retrospective Analysis of Thirty Four Cases

“…Flexible intramedullary nailing is a preferred fixation method for pediatric forearm fractures. Most series showed good to excellent results using this method (13)(14)(15). The rate of complications associated with TENs has been reported to be 15-67% in the literature (16,17).…”

Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures

“…[1,13,21–23] A wide range of complication rates between 15% and even 67% for intramedullary fixation is reported in the literature. [15,16] Flynn and Waters [24] reported a rate of 14.6%, Smith et al reported a rate of 42%, [25] whereas Shah et al [26] reported no complications after intramedullary nailing and Antabak et al [27] a rate of 25% in 88 children. In the present study population with a large cohort of 202 fractures, we observed a low total complication rate of 8.9%, of which only 6.9% required a second operative intervention.…”

“…[10–14] A wide range of complication rates have been reported in the literature. Salonen et al [15] reported in 2012 a complication rate of 67% in patients over 10 years and 33% in patients under 10 years. A complication rate of 15% was reported in a large cohort by Fernandez et al [16] in 2010.…”