Use of Elastic Stable Intramedullary Nailing for Treating Unstable Forearm Fractures in Children

Background: The majority of the pediatric diaphyseal forearm fractures are treated with closed reduction and the application of an above elbow cast for a varying period, depending on the age of the child. Some forearm diaphyseal fractures require osteosynthesis mainly because of the presence of an unacceptable angular deformity, fracture instability, presence of an open injury or failure of conservative management in the form of redisplacement in the cast after manipulation.

Methods: We present our experience with elastic stable intramedullary nailing (ESIN) for displaced and unstable pediatric diaphyseal fractures. A consecutive series of 21 patients treated with ESIN between 1997 and 2005 have been reviewed retrospectively. There were 14 boys and 7 girls with a median age of 11.8 years. All fixations were protected in an above elbow plaster cast. Patients were followed up for an average of 12.8 months (Range, 12-21.5 months).

Results: Clinical and radiologic union was achieved within 13 weeks after the procedure in 19 children. One patient had delayed union of the ulna which finally united at 9 months after operation without any further intervention. Another patient had nonunion of ulna that required autologous bone marrow injection after 1 year before full consolidation occurred. Complications were all modest and transient and eventually all patients achieved a good functional clinical outcome.

Conclusion: We think that the technique has many merits over a more traditional plating technique including a minimally invasive technique, a less time consuming procedure and easier metal work removal. We think that cosmesis is perhaps the most important to our patients because the wounds are small and less conspicuous than the traditional Henry approach for plating which leaves a long unsightly volar forearm scar. We think that ESIN is an attractive treatment option for displaced and unstable diaphyseal forearm fractures in children.