An Evaluation of the Efficacy of Flexible Nailing in the Management of Diaphyseal Forearm Fractures: A Prospective Study in Rural India's Healthcare Settings

Abstract

Introduction: High-speed accidents and trauma are becoming increasingly common and often result in forearm fractures in developing countries and even rural populations are not immune to such injuries. To address this issue, there has been a growing trend towards using flexible intramedullary nailing systems, such as the Titanium Elastic Nailing System (TENS). Methodology: This prospective study conducted at PES Institute of Medical Sciences and Research, Kuppam India, between June 2019 and March 2023 after receiving institutional ethical approval, patients with diaphyseal fractures of the forearm were treated with TENS, after their consent and, then followed up at 1st, 3rd, and 6th months post-operatively using Daruwalla's Clinical criteria. Result: The study involved 300 patients, with a male predominance (60%) and most common age group of 11-20 years old (26.7%) involving right forearm (63.3%), at middle third (76.7%) with transverse (80%) and closed (86.7%) nature. The leading cause was road traffic accidents (50%). At the first month, 86.7% had fair outcomes according to Daruwalla's grading, with 40% showing excellent outcomes by the 6th month. Over time, the proportion of patients with good (46.7%) and excellent (40%) outcomes increased, while fair and poor outcomes decreased (13.3%, 0%) Conclusion: TENS has shown efficacy in treating forearm fractures. Positive trends in clinical grading were seen, with a majority of patients achieving fair to excellent outcomes by the 6th month post-operative follow-up. These results support TENS, even in rural settings with limited resources, as a viable alternative to plate osteosynthesis. Keywords: Intramedullary Nailing, Forearm Injury, Fracture