Elastic stable intramedullary nailing for the treatment of forearm refractures in children.
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, adolescentsDownloads
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