Failures and complications in intramedullary nailing of children's forearm fractures

Abstract

The analysis of the failures and complications shows that a differentiated approach to the data has to be taken. Most complications occur because of incorrect use of the method with neglect of biomechanical principles. The usage of the ESIN method is extended to more problematic regions, such as the distal diaphyseal portion of the forearm, and therefore, an increase in complications is likely. Despite this risk, ESIN should still be the standard treatment for forearm shaft fractures in children, and no change in therapeutical strategy is necessary. However, it is of special importance to follow the right indication and to pay attention to biomechanical principles and to correct technical procedure.

Refractures of the paediatric forearm with the intramedullary nail in situ

“…In addition, two articles were identified from citation list of selected articles. In total we could find 11 studies or case reports referring to refractures of the forearm with ESIN in situ, accounting for 0.8–8.6% (average 2.3%) of study population5 6 11–19 (table 1). This complication typically occurs after a second trauma more than a month after the initial fracture.…”

Closed reduction of radius refracture: A case report

“…2 Perfect anatomic reductions of these fractures are not necessary in children, as their immature bones have the ability to remodel which may correct any residual deformity. 3 It has been reported that angulation of approx 10 degrees in children is likely to remodel overtime. 3 Operative fixation is indicated in a minority of cases.…”

“…3 It has been reported that angulation of approx 10 degrees in children is likely to remodel overtime. 3 Operative fixation is indicated in a minority of cases. This include fractures that are unstable, with an angulation of more than 10 degrees post closed reduction, displaced fracture of proximal third of radius, and in an open fracture.…”

“…[4][5][6] This technique was developed to be the standard treatment of unstable paediatric forearm fractures. 3 It has the advantages of a small surgical wound, short operative time and minimal neurovascular risk of injury. Most paediatric patients that undergo insertion of these intramedullary nails are placed in a cast for at least 4 weeks duration.…”

Influence of the bending of the tip of elastic stable intramedullary nails on removal and associated complications in pediatric both bone forearm fractures: A pilot study

“…The efficiency of this technique has been validated by many studies showing that the procedure is straightforward, reproducible, has good outcomes and few complications [6e8]. The most common reported complications after ESIN are by order of frequency refractures, lesion of the superficial radial nerve and delayed union [9]. With regards to the material used for ESIN, results are similar whether stainless steel Kirschner wires (K-wires) or titanium nails are used [10,11].…”