Elastic intramedullary nailing in the management of forearm fractures in children: A clinical study

Introduction: Forearm fractures are the most prevalent in childhood and adolescence and correspond to between 30% and 50% of all lesions that affect the immature skeleton. Successful treatment of fracture shafts of Radius and Ulna must aim at restoring full function of pronation and supination without which full use of hand is not possible. With conservative treatment, there are increased chances of redisplacement leading to high rates of failure. Intramedullary fixation is an attractive option because of short operative time, excellent cosmesis, minimal soft-tissue dissection, ease of hardware removal and early motion. Materials and Methods: This was a prospective study of 32 children of forearm fractures treated by elastic intramedullary nailing and their outcome. The study was conducted in the Department of Orthopaedics, Hindu Rao Hospital, Delhi in between March 2015 to April 2016. Forearm fractures of all children admitted through Emergency Department and Out Patient Department were included in the study. Their functional results were analysed using Price et al criteria. Results: Majority of patients were males accounting to 78.12% (n=25). Male to Female ratio was 3.6:1. Mean age of patients was 9.4 years with standard deviation (S.D) of 1.9. Fall during play accounted to majority of the cases (81.25%, n=26). Majority of the patients in this study had fractures on the left side accounting to 62.5% (n=20). Left: Right ratio was 5:3. Majority of the patients in this study had fracture both bone forearm (22A3) accounting for 53.12% (n=17). In majority of the patients, intra-operative reduction was achieved by closed means (87.5% n=28), while open reduction was required in (12.5% n= 4). Conclusion: Closed intramedullary fixation is a biological method of fixation with less damage to the muscles and the periosteum, the fracture hematoma is intact, thus leading to early bridging callus formation. The undisturbed surrounding muscles and soft tissues help in spontaneous post operative correction of slight angular deviation. All the cases in this study went on to unite with no incidence of non union. The functional outcome was found to be excellent in majority of the patients.