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Abstract
Purpose
In the present study, the usefulness of single bone flexible intramedullary nail fixation in pediatric displaced both forearm bone shaft fractures was evaluated.
Materials and Methods
From 2006, we treated 14 consecutive pediatric both forearm bone shaft fractures using a single bone flexible intramedullary fixation. The average age of patients was 8.6 years (range, 3-12 years). We nailed the one bone of the two that showed either greater deformity in the initial radiographs, or difficulty in maintaining reduction, which in our cases was usually the radius. The operation time, duration of cast removal, functional recovery and complications were evaluated. The bony alignment, maintained until bony union, was analyzed by radiographic assessment. These data were compared with 27 cases of both bone nailing, which was the standard treatment in our institution prior to 2006.
Results
All cases in both groups healed without secondary intervention. All cases recovered to a normal functional status after postoperative average 12 weeks. In regards to their clinical and radiographic results, there was no significant difference between the single bone fixation group and the both bone fixation group, except that there was a shorter operation time, and longer period of cast immobilization, for the single bone fixation group.
Conclusion
Single bone flexible intramedullary fixation is a useful method for the treatment of displaced forearm bone shaft fractures in children. The strategy of fixating the bone that exhibits greater deformity or difficulty in maintaining reduction, which was usually the radius, was found to be effective in our cases.
Figures and Tables
Figure 1
Fixation principle I: The more displaced bone was fixated. (A) Preoperative radiograph of a 12-year-old girl shows the radius was more displaced. (B) Intraoperative fluoroscopy shows the radius was fixated, as it was more displaced. The alignment of the ulnar and its stability were maintained after single bone intramedullary fixation of the radius. (C) Final radiograph shows the alignment of both forearm bones was well maintained until bony union was achieved.
Figure 2
Fixation principle II: The bone more difficult to reduce or control was fixated. (A) Preoperative radiograph of a 8-year-old boy shows both bones were equally displaced. (B) Intraoperative fluoroscopy shows the radius was fixated, as the radius was usually more difficult to reduce and maintain its reduction. The alignment of the ulna and its stability were maintained after single bone intramedullary fixation of the radius. (C) Radiograph shows the alignment of both forearm bones was well maintained until bony union was achieved.
Figure 3
A complication occurring in single bone intramedullary fixation. (A) Radiograph was taken just before nail removal at postoperative 13 months. (B) A fracture developed at the entry site of the nail during the difficult procedure of nail removal.
Table 3
Evaluation of Radiologic Alignment of 14 Patients Treated by Single Bone Intramedullary Fixation*
*Significant reduction was achieved for the ulna and radius as assessed on AP and lateral planes at postoperative (p=0.001) and follow-up (p=0.001) (Wilcoxon signed-rank tests). No significant loss of reduction between postoperative and follow-up was observed for any variable (p>0.05). AP, anteroposterior; IQR, interquartile range.
References
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