Closed reduction and Nancy nail fixation for forearm fractures in children

Abstract

Background Forearm fractures in children are common. Children forearm fractures are managed differently than are similar injuries in adults. Treatment alternatives of irreducible unstable pediatric forearm fractures are closed remanipulation under general anesthesia and casting, Kirschner wire and casting, closed or miniopen reduction and intramedullary fixation, and open reduction and internal fixation with plates. The intramedullary nail fixation is preferable in many circumstances to open reduction and plating of the forearm bones as it prevents stripping of the soft tissues; in addition, there is little in the way of surgical scar tissue and is therefore cosmetically acceptable. Patients and methods Thirty-six [32 (88.8%) boys and four (11.2%) girls] patients with fractures of both bones of the forearm were treated with elastic stable intramedullary nails. The surgery was performed within 20 h (range: 12 h–2 days). The fractures were classified according to the Orthopedic Trauma Association classification. All operations were carried out under general anesthesia and under an image intensifier control. Closed manipulation of fractures was performed to correct the length, rotation, and angulation. Blunt-ended 1.5–2.5-mm diameter titanium nails were used. An above elbow splint was applied. Results Functional results were evaluated according to the criteria of Price and colleagues. An excellent result was achieved in 30 (83.3%) patients and a good result in six (16.7%) patients. Three (8.3%) patients had olecranon bursitis due to irritation of the nail, which was resolved after nail removal. Two (5.6%) patients had superficial wound infection (redness and hotness) at the entry site of radial nail and were treated with repeated dressings and empirical antibiotics for 10 days. Conclusion The advantages of an elastic intramedullary nail fixation for the radius and ulna fractures are that it is technically straightforward, allows a high rate of osseous consolidation, is minimally invasive, and allows early mobilization.