A new mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: a preliminary technical report

Abstract

Background and Aim: Operative treatment is often indicated in unstable pediatric diaphyseal forearm fractures. Recently minimally invasive reduction and elastic stable intramedullary nailing have been of increasing interest, instead of open reduction and internal fixation with plates. There are several disadvantages of metallic intramedullary implants, such as soft-tissue irritation and a risk of disturbing later imaging. Thus, they are generally removed in later operations. we aimed to develop a new technique to stabilize pediatric forearm fractures by the bioabsorbable intramedullary nailing.Material and Methods: we developed a new, two-stage mini-invasive surgical technique to stabilize the unstable diaphyseal fractures in children. The procedure is bioabsorbable elastic stable intramedullary nailing. ultra-high-strength bioabsorbable intramedullary nails of poly(lactide-co-glycolide) were manufactured for our purpose. The material has been widely proven to be biocompatible and stable enough for fracture treatment as screws and pins. we have used the new technique in the unstable both-bone diaphyseal forearm fractures in children between the ages of 5 and 15 years. we report the technique and our clinical experience in the series of those three cases that have been followed up for at least 12 months. The present series has been randomized for the procedure instead for titanium elastic stable intramedullary nailing, and the series represents a part of ongoing randomized trial.

Nonoperatively treated forearm shaft fractures in children show good long-term recovery

“…In our opinion, the main reason for the increase in ESIN is its good immediate outcome and the lack of major short-term complications compared with nonoperative treatment ( Kay et al 1986 , Salonen et al 2012 , Sinikumpu et al 2012a , Colaris et al 2013 ). The technique is trendy, and a new method based on biodegradable intramedullary nailing has been described ( Sinikumpu et al 2013a ). Despite its popularity, the indications for ESIN are still controversial ( Abraham et al 2011 ).…”

The shaft fractures of the radius and ulna in children

“…3). There is a new innovative technique, BESIN (biodegradable-elasticstable-intramedullary-nailing), under on-going clinical evaluations [46]. ESIN is usually made of titanium or stainless steel.…”

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

“…Removal predisposes children to operation-related risks and causes psychosocial stress. The cost of implant removal is approximately $1,900 in a developed country [30][31][32][33] . There are also some institutions that prefer leaving the implants or removing only symptomatic ones 29,[34][35][36] even though, it is not widely understood how metallic implants affect the natural modeling of the forearm.…”

“…There has been increasing interest in biodegradable materials in trauma surgery 33,[39][40][41][42][43] . A new miniinvasive procedure to treat unstable forearm fractures with Biodegradable Intramedullary Nailing (BIN) has been developed 32 . Biodegradable nails are designed to maintain mechanical strength but to be absorbed during bone healing.…”

“…Degradation of the implant material occurs both by hydrolysis and by way of physiological pathways. The operative procedure is mostly similar to that in ESIN stabilization 26,32 . However, reaming through the whole medullary cavity until the planned end of the rodding is recommended, after which the implants are introduced by pushing and slightly tapping the nails into the cavity.…”