Abstract
There are published studies of outcomes in the use of ESIN that raise concerns about serious complications: the aim of this study is to report our experiences over 17years of use of this technique, which shows that complications and failures are insignificant when the method is applied correctly. We present a retrospective analysis of 553 children with forearm shaft fractures treated with elastic stable intramedullary nailing over a period of 17years. The 354 boys (64%) and 199 girls (36%) had an average age of 9.1years. A total of 61% of the fractures were located in the midshaft, 21% in the distal diaphyseal and 18% in the proximal third. Continuous documentation of treatment, postoperative course and follow-up after an average time of 37months formed the basis of this study. The analysis included all kinds of failures and complications. The following complications and problems were encountered: 5 children with wound infections and disturbed wound healing, 1 case of osteomyelitis, 7 children with ulnar non-unions, 14 children with delayed unions, 6 cases of loss of correction, 15 children with lesions of the superficial radial nerve, one case of malplacement of a nail, 5 children with skin perforations caused by the ends of implants and 27 children with refractures. 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.
Highlights
With approximately 6% of all fractures in children forearm shaft fractures are quite a frequent fracture until the mid 1990s, the conservative therapy of infantile and adolescent forearm fractures with an upper arm cast was regarded as ‘‘gold standard’’
Purpose There are published studies of outcomes in the use of Elastic stable intramedullary nailing (ESIN) that raise concerns about serious complications: the aim of this study is to report our experiences over 17 years of use of this technique, which shows that complications and failures are insignificant when the method is applied correctly
We present a retrospective analysis of 553 children with forearm shaft fractures treated with elastic stable intramedullary nailing over a period of 17 years
Summary
With approximately 6% of all fractures in children forearm shaft fractures are quite a frequent fracture until the mid 1990s, the conservative therapy of infantile and adolescent forearm fractures with an upper arm cast was regarded as ‘‘gold standard’’. In children younger than 10 years, perfect anatomic reduction is not necessary because remodeling may correct residual deformity [1, 2]. Fuller [6] concluded that the loss of supination and pronation is proportional to the reduction of rotational malunion. He noted that in malunion no spontaneous correction of deformity occurs in girls older than 8 years and in boys older than 10 years of age. A near-anatomic reduction is necessary in children older than 10 years to preserve full range of motion [2,3,4]. Frequent problems after conservative treatment, such as loss of correction with the necessity of repeated reduction as well
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