Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children
Volume 4 | Issue 1 | January-June 2018 | Page: 29-33 | Deeptiman James, Vrisha Madhuri
DOI- 10.13107/ijpo.2018.v04i01.007
Authors: Deeptiman James, Vrisha Madhuri
Paediatric Orthopaedics Unit, Christian Medical College, Vellore, Tamil Nadu, India
Address of Correspondence
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: madhuriwalter@cmcvellore.ac.in
Abstract
Aims: To determine the clinical profile and clinical, functional, and radiological outcomes and complications in children who underwent elastic stable intramedullary nailing (ESIN) for unstable fractures of both bones of forearm. Materials and Methods: A retrospective observational study was conducted in the Paediatric Orthopaedic Unit of the institution. Children with forearm fractures, who underwent ESIN of both the bones with titanium nails from January 2004 to June 2010, were included in the study. Clinical evaluation for deformity, range of motion at wrist and elbow, Daruwalla’s grading for forearm fractures, and radiological evaluation for bony union, malalignment, and radial bow were done. Paediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to assess functional outcome.
Results: Twenty-six patients were followed up for a mean of 2.14 years. These included one primary internal fixation for unstable injury in a 15-year old, 10 open fractures, and 15 with malalignment after closed reduction. Age ranged from 5 to 15 years (mean of 11.39). Average time to bony union was 6 weeks. Twelve children had excellent, 12 good, and two fair outcomes according to Daruwalla’s grade. Average PODCI score was 50.78 (standardized range is minimum of −140 to maximum of 53). There were no major complications related to ESIN. Three patients had paraesthesia over superficial radial nerve distribution, three patients had hypertrophied scars, and one patient had superficial wound infection. One child had distal radial physeal arrest following inadvertent physeal injury during implant removal.
Conclusion: ESIN is safe and effective for internal fixation of unstable forearm fractures.
Keywords: ESIN, Paediatric both bones forearm fractures, PODCI questionnaire
References
1. Noonan KL, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146-56.
2. Madhuri V, Dutt V, Gahukamble AD, Tharyan P. Conservative interventions for diaphyseal fractures of the forearm bones in children. Cochrane Database Syst Rev 2013;2013:CD008775.
3. Anderson D, Sisk TD, Tooms RE, Park WI III. Compression plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 1975;57:287-96.
4. Hughston JC. Fractures of the forearm in children. An Instructional Course Lecture, the American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am 1962;44-A: 1678-87.
5. Fuller DJ, McMullough CJ. Malunited fractures of the forearm in children. J Bone Joint Surg 1982;64:364-7.
6. Creasman C, Zaleske DJ, Ehrilch MG. Analyzing forearm fractures in children. The more subtle signs of impending problems. Clin Orthop Relat Res 1984;188:40-53.
7. Gandhi RK, Wilson P, Mason-Brown JJ, Macleod W. Spontaneous correction of deformity following fractures of the forearm in children. Br J Surg 1962;50:5-10.
8. Flynn JM, Sarwark JF, Waters PM, Bae DS, Lenke LP. The operative management of pediatric fractures of the upper extremity. J Bone Joint Surg Am 2002;84:2078-98.
9. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990;10:167-71.
10. Luhmann SJ, Gordon JE, Shoenecker PL. Intramedullary fixation for unstable both bones forearm fractures in children. J Pediatr Orthop 1998;18:451-5.
11. Blackburn M, Ziv I, Rang M. Correction of malunited forearm factures. Clin Orthop Relat Res 1984;188:54-7.
12. Amit Y, Salai M, Chechik A, Blankslein A, Horoszowski H. Closed intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence − a prelimnary report. J Pediatr Orthop 1985;5:143-6.
13. Pankovitch AM. Flexible intramedullary nailing of long bone fractures. A review. J Orthop Trauma 1987;1:78-95.
14. Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury 2005;36(Suppl 1):A25-34.
15. Firl M, Wunsch L. Measurement of bowing of the radius. J Bone Joint Surg Br 2004;86:1047-9.
16. Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 1979;139:114-20.
17. American Association of Orthopedic Surgeons (AAOS) Outcome Instrument scores. Available from: http://www.aaos.org/research/outcomes_documentatio.asp [Last accessed on 2016 May 18]
18. Shah AS, Lesniak BP, Wolter TP, Caird MS, Farley FA, Vander Have KL. Stabilization of adolescent both bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma 2010;24:440-7.
19. Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP. Elastic intramedullary nailing: A minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 1998;18:457-61.
20. Case collection of forearm fractures. AO manual of fracture management. In: Dietz HG, Schittenbecher PP, Slongo T, Wilkins KE, editors. Elastic stable intramedullary nailing in children. Richmond, TX, USA: AO Publishing, Thieme; 2006. p. 71-108.
21. Jubel A, Andermahr J, Isenberg J, Issanvand A, Axel R, Klause E. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop 2005;14:375-80.
22. Bhasker A. Treatment of long bone fractures in children by flexible titanium elastic nails. Indian J Orthop 2005;39:166-8.
23. Fernandez FF, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: Plate fixation versus intramedullary nailing. Injury 2005;36:1210-6.
24. Flynn JM, Waters PM. Single bone fixation of both bone forearm fractures. J Pediatr Orthop 1996;16:655-9.
25. Suzanne BK, Jaffe KA, Petur NG, Rosenberg AE. Orthopaedic implant-related sarcoma: A study of twelve cases. Mod Pathol 2001;14:969-77.
26. Ballal MS, Garg NK, Bruce CE, Bass A. Nonunion of the ulna after elastic stable intramedullary nailing for unstable forearm fractures; a case series. J Pediatr Orthop B 2009;18:261-4.
27. Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Orthop Trauma 2008;65:109-15.
28. Lieber J, Joeris A, Knorr A, Schalamon J, Schmittenbecher PP. ESIN in forearm fractures, clear indications, often used, but some avoidable complications. Eur J Trauma 2005;31:3-11.
29. Slongo TF. Complications and failures of the ESIN technique. Injury 2005;36(Suppl 1):A78-85.
30. Adamczyk MJ, Riley PM. Delayed union and nonunion following closed treatment of diaphyseal pediatric forearm fractures. J Pediatr Orthop 2005;25:51-5.
| How to Cite this Article: James D, Madhuri V | Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children | January-June 2018; 4(1): 29-33.
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