Observations on Intramedullary Nailing in Diaphyseal both Bone Forearm Fractures in Children

Purpose: Observations on intramedullary nailing in diaphyseal both bone forearm fractures in children aged 8-14 years. Patients and Methods: 50 patients with an age group of 8-14 years, with displaced unstable diaphyseal forearm fractures, including the segmental and open fractures (Gustilo& Anderson type 1& 2) and fractures with loss of reduction in the first week of casting were included in the study. Intramedullary nailing of both bone forearm fractures was done under general anaesthesia using 2-2.5mm diameter flexible titanium nails. Patients were followed at two weeks, four weeks, six weeks, eight weeks and then at monthly intervals upto 9 months. Final follow up was done at 9 months and results were assessed clinically using Daruwalla criteria with restoration of forearm rotation. Results: Majority of patients (72 %) were in the age group of 11-14 years with an average age of 11 years. Male children (76 %) outnumbered the females (24 %). Majority of the patients had involvement of left side (68 %) as compared to right side (32 %). Mode of injury was sports related fall in 22 (44 %) patients, fall from height in 14 (28 %) patients, fall from bicycle in 7 (14 %) patients& road traffic accident (RTA) in 7 (14 %) patients. Summer was season with maximum number of patients (42 %) followed by spring (26 %), autumn (24 %)& winter (8 %). Middle third of the radius& ulna was most common site of fracture (52 %), followed by distal third (38 %)& least involved site was proximal third (10 %) of forearm.12 % of the fractures were open type (Gustillo Type 1 and 2) while 88 % were closed type. Fracture pattern was transverse in 34 (68 %) and Oblique 16 (32 %) cases. Average time from injury to intervention was 37 hours. In 38 (76 %) cases, closed reduction and nailing was achieved using 2 to 2.5 mm flexible titanium nails while in 12 (24 %) cases, open reduction through limited incisions was done. The average surgical time was 40 minutes. The average hospital stay was 2.3 days. The average union time was 8 weeks with a range of 6-12 weeks. In all patients, removal of implant was done at 6 months. At final follow up, excellent results were seen in 46 (92 %) patients& good results in 04 (8 %) patients using Daruwalla criteria with restoration of forearm rotation. Conclusion: In children aged 8-14 years, the displaced diaphyseal forearm fractures, including open fractures (Gustilo& Anderson type 1& 2) and fractures with loss of reduction in the first week of casting can be treated by intramedullary nailing with good to excellent functional results.