English

Abstract

In the management of displaced forearm shafts fractures it is very important to regain the length of the bones, maintaining the radial bow, good apposition and alignment without any malrotation, early mobilization of wrist and elbow to get good results. Closed intra medullary nailing of these fractures can be considered as a good alternative method to the plating. We had devised the forearm fracture table which was very useful in getting a sustained traction reducing the clumsiness, difficulty, incoordination usually experienced in doing closed forearm nailing without the fracture table. In 8 out of 32 cases we could not get closed nailing, mini open nailing was done. In 23 cases where closed nailing was done all the fractures united with mean time for union 15 weeks. The average duration of post operative immobilization in the present study is 4.9 weeks, which ranged from 3 weeks to 8 weeks. The satisfactory and excellent functional results in 21 of 23 cases (91.2%) can be attributed to good and excellent anatomical reduction of the fracture, and early mobilization. INTRODUCTION: The fractures of the shafts of the forearm bones are the one of the most difficult fractures of the shafts of long bones 1 . The shortening, angulation, malunion, malrotation of either of these bones may result in a serious loss of elbow and wrist movements and pronation, supination of the forearm affecting the earning capacity of the individual as well as his day to day activities 2. Even though the deformity may look minimal, the disability is very crippling. The rotations of the forearm, movements of the wrist and elbow help to keep the hand in space so that the whole upper limb can function properly. To avoid the crippling disabilities associated with these fractures, it is very important to regain the length of the bones, good apposition and alignment without any malrotation, maintaining the radial bow, early mobilization of wrist and elbow 3. Any compromise in these will definitely not give good results. Open reduction and internal fixation with dynamic plate and screws is considered the best method to treat the displaced fractures of shafts of forearm in adults 4 . But this technique is very invasive with big operative wounds and big non-cosmetic scars. The risk of refracture after the removal of plates & screws is between 4-25% 5, 6,7,8,9 . Closed intra medullary nailing of these fractures can be considered as a good alternative method. The procedure is minimally invasive and preserves the whole biology of fracture healing 10. Intra medullary nails are load sharing devices and there is secondary bone healing with good callus 11, hence may not need cast immobilization after nail removal. The nail removal is also involves small incisions. So the present study was undertaken to evaluate the results of closed intramedullary nailing for diaphyseal fractures of the forearm bones in adults. In this study the anatomical reduction of the fractures, rate of union, time taken for union, the complications, the functional results in terms of forearm rotations and wrist and elbow movements are studied and the advantages and disadvantages of the procedure are also evaluated. We used a unique indigenously made radiolucent