Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing

Abstract

PurposeIn the surgical treatment of paediatric forearm fractures, plate-screw and titanium elastic nails are used. During the transformation of ligamento-osseous structures from adolescence form into adult form, more stable fixation is required. The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures. MethodsA retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture. The included patients were in the adolescent age group (12–17 years), did not meet conservative follow-up criteria and had unstable fractures (>10° angulation and <50% cortex continuity after plaster casting). Patients were excluded from the study if they were aged >18 years or <12 years, had Gustilo-Anderson type 2/3 open fractures, multi-trauma, history of physeal injuries or could not be contacted during follow-up. Patients’ age, gender, body mass index, affected side, and the pronation and supination values during follow-up were noted. Functional evaluation of the patients was performed with disabilities of the arm, shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria. The time to union, infection during follow-up, re-fracture and vascular nerve damage were also examined. Data were analyzed using SPSS 22 Windows package program software. ResultsThe patients comprised 30 males and 6 females (ratio, 5:1) with a mean age of (14.7 ± 2.1) years (range, 12–18 years). According to the Price criteria, the results of 33 patients were excellent, 3 were good and there were no moderate or poor cases. The mean disabilities of the arm, shoulder and hand score was 11.2 ± 6.1 (range, 4–28). The mean time to union was (8.7 ± 2.2) weeks (range, 6–14 weeks), while patients aged >15 years had prolonged time to union ([11.1 ± 1.8] weeks). There were no non-unions, re-fractures or infections. No complications were observed during implant removal. None of the patients had sensorial radial nerve injury or tendon damage. ConclusionThe locked intramedullary nailing technique, which is minimally invasive and provides biological fixation, was found to be successful and safe in the treatment of adolescent forearm fractures.