Clinical Outcomes of Management of Pediatric Diaphyseal Forearm Fractures Using Flexible Elastic Nailing

Abstract

Background: Diaphyseal forearm fracture are common injuries among children, its treated either conservatively or surgically, closed reduction cast immobilization remain the current gold standards for treating these injures, but angular & rotational malunion result in functional disability in older children. Intramedullary nailing of forearm fracture is an alternative method especially in case of failed closed reduction and cast immobilization. The aim of our study is to value the outcome of using flexible elastic nail in pediatric diaphyseal forearm fractures. Methods: This study is a prospective study was conducted in Erbil city from January 2016 to January 2017 on forty-nine pediatric patients with diaphyseal forearm fractures treated surgically with titanium elastic nailing system (TENS), thirty-three boys & sixteen girls, twenty-one fractures on right side and twenty-eight on left side, age range between 5-15 years with mean age of 9 3.1three patients had polytraumatic injury , the fracture had been classified according to descriptive classification, Average follow up was11± 2months for 43 children. Result: In 43 of 49 patients, the operative procedure was done as primary treatment, completed within the first 24 hours after injury. In six of the patients, secondary displacement occurred after attempted conservative therapy, and in those cases the procedure was performed after 8 ± 3 days. Operating time averaged 42 ± 15 min. The average time that radiographs showed bridging callus on the antero-posterior and lateral views was 13 weeks for both radius and ulna, Ten of the 49 patients were given aboveelbow splints postoperatively, Implant removal was performed after an average of 6.3 ± 1.7 months, the radiological results are documented regarding angulation and displacement. The functional results are documented, there were no observed cases of refracture, 6 months after hardware removal all patients pain free with no limitation of movement and activities, 37 patients were rated as excellent outcome, three with good out come and three with poor out comes. Conclusion: Flexible elastic nail is an effective and minimally invasive method of diaphyseal forearm fractures with excellent results in terms of bony union and functional out comes with minimal complications and without jeopardizing the integrity of the physes.