Elastic stable intramedullary nailing for the treatment of forearm refractures in children.
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Published:
Nov 13, 2018
Keywords:
Re-fractures, forearm, elastic intramedullary nailing, children, adolescents
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Abstract
IntroductionForearm diaphysis is the most frequent site of refractures in children. These lesions usually occur in the middle or proximal third within a year of the initial fracture. There is little information available on the treatment in this type of injuries. The aim of this study was to evaluate outcomes and complications in patients with re-fractures of the forearm that required internal fixation with elastic stable intramedullary nails (ESIN).MethodsDemographic data, mechanism of injury, classification, time elapsed from consolidation of the original fracture to refracture, type of reduction and time of consolidation were documented. Outcomes were evaluated according to Martus, and the complications with an adaptation of the Clavien-Dindo classification.Results17 patients (14 male) with 17 forearm re-fractures (15 closed and 2 open) were identified. Median age was 11 years (IQR 7, min-max 5-15 years). The lesion occurred 12 weeks after the initial fracture (RIC 4.7, min-max 4-28 weeks). Forty-seven percent required open reduction. Union was achieved at 8 weeks (IQR 4, min-max 6-28 weeks). The follow-up was 43 months (IQR 47, min-max 12-103 months). Sixteen patients were clinically evaluated (1 lost of follow-up). Fifteen patients presented excellent results and one fair. One patient had 15º loss of motion, one had a delayed union (ulna) and three patients had a second re-fracture.ConclusionIn this series, ESIN represented an effective technique for the treatment of forearm re-fractures in children. Although many require open reduction, time to union and complication rate seems to be similar to primary fractures treated with the same technique. Keywords: Re-fractures, forearm, elastic intramedullary nailing, children, adolescents
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Eamara, P., & Masquijo, J. J. (2018). Elastic stable intramedullary nailing for the treatment of forearm refractures in children. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(4), 242-247. https://doi.org/10.15417/issn.1852-7434.2018.83.4.813
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Clinical Research
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References
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2. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am 2008;33(10):1911-23. doi: 10.1016/j.jhsa.2008.10.013
3. Baitner AC, Perry A, Lalonde FD, Bastrom TP, Pawelek J, Newton PO. The healing forearm fracture: a matched comparison of forearm refractures. J Pediatr Orthop 2007;27(7):743-7. doi: 10.1097/BPO.0b013e318142568c
4. Tisosky AJ, Werger MM, McPartland TG, Bowe JA. The factors influencing the refracture of pediatric forearms. J Pediatr Orthop 2015;35(7):677-81. doi: 10.1097/BPO.0000000000000355
5. Lascombes P, Haumont T, Journeau P. Centromedullary nailing for fracture of both forearm bones in children and adolescents.
Rev Chir Orthop Reparatrice Appar Mot 2006;92:615-25. PMID: 17088761
6. Wall L, O’Donnell JC, Schoenecker PL, Keeler KA, Dobbs MB, Luhmann SJ, et al. Titanium elastic nailing radius and ulna fractures in adolescents. J Pediatr Orthop B 2012;21(5):482-8. doi: 10.1097/BPB.0b013e3283528db5
7. Makki D, Matar HE, Webb M, Wright DM, James LA, Ricketts DM. Elastic stable intramedullary nailing in paediatric forearm fractures: the rate of open reduction and complications. J Pediatr Orthop B 2017;26(5):412-6.
doi: 10.1097/BPB.0000000000000408
8. Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population
during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B 2016; 25(5):439-46. doi: 10.1097/BPB.0000000000000278
9. Kelly BA, Shore BJ, Bae DS, Hedequist DJ, Glotzbecker MP. Pediatric forearm fractures with in situ intramedullary implants. J Child Orthop 2016;10(4):321-7. doi: 10.1007/s11832-016-0746-4
10. McLean C, Adlington H, Houshian S. Paediatric forearm refractures with retained plates managed with flexible intramedullary nails. Injury 2007;38(8):926-30. doi: 10.1016/j.injury.2006.10.029
11. Slongo T, Audigé L, Clavert JM, Lutz N, Frick S, Hunter J. The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study. J Pediatr Orthop 2007;27(2):171-80. doi: 10.1097/01.bpb.0000248569.43251.f9
12. Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA. Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 2013;33(6): 598-607. doi: 10.1097/BPO.0b013e3182a11d3b
13. Clavien P, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications. Ann Surg 2009;250:187-96. doi: 10.1097/SLA.0b013e3181b13ca2
14. Dindo D, Demartines N, Clavien P. Classification of surgicalcomplications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;2004:205-13. doi: 10.1097/01.sla.0000133083.54934.ae
15. Muensterer OJ, Regauer MP. Closed reduction of forearm refractures with flexible intramedullary nails in situ. J Bone Joint Surg Am 2003;85(11): 2152-5. PMID: 14630845
16. Fernandez FF, Eberhardt O, Langendorfer M, Wirth T. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B 2009;18(6):289-95. doi: 10.1097/BPB.0b013e32832f5b20
17. 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(2):167-71. PMID: 2312694
18. Schmittenbecher PP, Fitze G, Godeke J, Kraus R, Schneidmuller D. Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 2008;28(3):303-6. doi: 10.1097/BPO.0b013e3181684cd6
19. Flynn J, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop 2010;30:313-8. doi: 10.1097/BPO.0b013e3181d98f2c
20. Kang SN, Mangwani J, Ramachandran M, Paterson JM, Barry M. Elastic intramedullary nailing of paediatric fractures of the forearm: a decade of experience in a teaching hospital in the United Kingdom. J Bone Joint Surg Br 2011;93:262-5. doi: 10.1302/0301-620X.93B2.24882
21. Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of pediatric both-bone forearm fractures: a comparison of operative
techniques. J Pediatr Orthop 2005;25:309-13. PMID: 15832144
2. Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am 2008;33(10):1911-23. doi: 10.1016/j.jhsa.2008.10.013
3. Baitner AC, Perry A, Lalonde FD, Bastrom TP, Pawelek J, Newton PO. The healing forearm fracture: a matched comparison of forearm refractures. J Pediatr Orthop 2007;27(7):743-7. doi: 10.1097/BPO.0b013e318142568c
4. Tisosky AJ, Werger MM, McPartland TG, Bowe JA. The factors influencing the refracture of pediatric forearms. J Pediatr Orthop 2015;35(7):677-81. doi: 10.1097/BPO.0000000000000355
5. Lascombes P, Haumont T, Journeau P. Centromedullary nailing for fracture of both forearm bones in children and adolescents.
Rev Chir Orthop Reparatrice Appar Mot 2006;92:615-25. PMID: 17088761
6. Wall L, O’Donnell JC, Schoenecker PL, Keeler KA, Dobbs MB, Luhmann SJ, et al. Titanium elastic nailing radius and ulna fractures in adolescents. J Pediatr Orthop B 2012;21(5):482-8. doi: 10.1097/BPB.0b013e3283528db5
7. Makki D, Matar HE, Webb M, Wright DM, James LA, Ricketts DM. Elastic stable intramedullary nailing in paediatric forearm fractures: the rate of open reduction and complications. J Pediatr Orthop B 2017;26(5):412-6.
doi: 10.1097/BPB.0000000000000408
8. Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population
during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B 2016; 25(5):439-46. doi: 10.1097/BPB.0000000000000278
9. Kelly BA, Shore BJ, Bae DS, Hedequist DJ, Glotzbecker MP. Pediatric forearm fractures with in situ intramedullary implants. J Child Orthop 2016;10(4):321-7. doi: 10.1007/s11832-016-0746-4
10. McLean C, Adlington H, Houshian S. Paediatric forearm refractures with retained plates managed with flexible intramedullary nails. Injury 2007;38(8):926-30. doi: 10.1016/j.injury.2006.10.029
11. Slongo T, Audigé L, Clavert JM, Lutz N, Frick S, Hunter J. The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study. J Pediatr Orthop 2007;27(2):171-80. doi: 10.1097/01.bpb.0000248569.43251.f9
12. Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA. Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 2013;33(6): 598-607. doi: 10.1097/BPO.0b013e3182a11d3b
13. Clavien P, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications. Ann Surg 2009;250:187-96. doi: 10.1097/SLA.0b013e3181b13ca2
14. Dindo D, Demartines N, Clavien P. Classification of surgicalcomplications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;2004:205-13. doi: 10.1097/01.sla.0000133083.54934.ae
15. Muensterer OJ, Regauer MP. Closed reduction of forearm refractures with flexible intramedullary nails in situ. J Bone Joint Surg Am 2003;85(11): 2152-5. PMID: 14630845
16. Fernandez FF, Eberhardt O, Langendorfer M, Wirth T. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B 2009;18(6):289-95. doi: 10.1097/BPB.0b013e32832f5b20
17. 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(2):167-71. PMID: 2312694
18. Schmittenbecher PP, Fitze G, Godeke J, Kraus R, Schneidmuller D. Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 2008;28(3):303-6. doi: 10.1097/BPO.0b013e3181684cd6
19. Flynn J, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop 2010;30:313-8. doi: 10.1097/BPO.0b013e3181d98f2c
20. Kang SN, Mangwani J, Ramachandran M, Paterson JM, Barry M. Elastic intramedullary nailing of paediatric fractures of the forearm: a decade of experience in a teaching hospital in the United Kingdom. J Bone Joint Surg Br 2011;93:262-5. doi: 10.1302/0301-620X.93B2.24882
21. Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of pediatric both-bone forearm fractures: a comparison of operative
techniques. J Pediatr Orthop 2005;25:309-13. PMID: 15832144