Abstract
Aims
To evaluate the results of Elastic Stable Intramedullary Nailing (ESIN) for displaced, unstable paediatric forearm diaphyseal fractures.
Method
A retrospective, consecutive series study of 60 patients treated with ESIN between February 1996 and July 2005.
Results
There were 43 (72%) boys and 17 (28%) girls with median age of 11.5 years (range: 2.6-15.9). 54 (90%) patients had a closed injury and 6 (10%) sustained a Grade I open injury. Seven patients had an isolated radius fracture. 49 (82%) fractures were stabilised with both bone ESIN, 10 (16%) with radial and one with isolated ulnar ESIN by standard technique under tourniquet control. All but two patients were protected with an above elbow cast. Thirty-six cases (60%) were primary procedures and 24 (40%) were performed due to re-displacement following a MUA. 36 patients (60%) required a minimal open reduction. Average hospital stay was 1.8 days (1-8 days). Average length of immobilisation was 5.4 weeks (3-9 weeks). Average time for clinical fracture union was 5.7 weeks (3-13 weeks). ESIN were removed after mean period of 33.8 weeks (approx: 7.9 months). One patient had a forearm compartment syndrome and required formal fasciotomy. One patient had ulnar delayed union and one had ulnar non-union. Five patients had transient superficial radial nerve neuropraxia. Ten had soft tissue irritation leading to early nail removal in two patients and two had superficial wound infection. Three patients sustained a re-fracture with the nail in situ following a new injury. 53 (88%) patients had full elbow and wrist movements on discharge. Seven patients had restriction of forearm rotations of less than 15°.
Conclusion
Good clinical outcome, transitory and modest complications; quick and safe nail removal; and better cosmesis compared to plating makes ESIN an attractive treatment option for displaced, unstable paediatric forearm diaphyseal fractures.
