Evaluation of functional outcome of forearm fracture in children treated with elastic nail (TENs)

G V Shiva Kumar; P R Sudheendra; H G Kiran Kumar; G Naveen Bharat

doi:10.53730/ijhs.v6nS2.7620

Authors

Shiva Kumar G V Assistant Professor, Department Of Orthopaedics, McGann Teaching Hospital, Shimoga Institute Of Medical Sciences, Shivamogga
Sudheendra P R Associate Professor, Department Of Orthopaedics, McGann Teaching Hospital, Shimoga Institute Of Medical Sciences, Shivamogga
Kiran Kumar H G Associate Professor, Department Of Orthopaedics, McGann Teaching Hospital, Shimoga Institute Of Medical Sciences, Shivamogga
G Naveen Bharat Assistant Professor, Department Of Orthopaedics, McGann Teaching Hospital, Shimoga Institute Of Medical Sciences, Shivamogga

Keywords:

children, pediatric forearm fractures, titanium elastic nails (TENs)

Abstract

Background: Forearm fractures are one of the most common injuries sustained by children and both bone forearm fractures are estimated around 40% of all pediatric fractures. Pediatric forearm fractures occur in approximately 1 in 100 children per year. Forearm shaft fractures in children are usually treated with closed reduction and cast immobilization and a good functional outcome is obtained, but few patients with gross displacement, angulations, soft tissue swelling due to edema, children nearing skeletal maturity, proximal third fractures, open fractures and displacement after closed manipulation and cast immobilization require surgical intervention. Greater controversy exists regarding the optimal method of fixation in children. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either intramedullary nails or open reduction and internal fixation with plates. The purpose of this study was to investigate the indications, techniques, clinical results, functional outcomes, possible complications and means of avoiding them in unstable forearm fractures in children treated with titanium elastic nails (TENs). Methods: Our prospective interventional study included Forty five children after application of inclusion and exclusion criteria, consent for study was taken from the parents.

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References

Fenton P, Nightingale P, Hodson J, Luscombe J. Factors in redisplacement of paediatric distal radius fractures. J Pediatr Orthop B 2012; 21: 127-30

Asadollahi S, Pourali M, Heidari K. Predictive factors for re-displacement in diaphyseal forearm fractures in children-role of radiographic indices. Acta Orthop. 2017;88(1):101-108. doi:10.1080/17453674.2016.1255784

Luhmann SJ, Gordon JE, Shoenecker PL. Intramedullary fixation of unstable both-bone forearm fractures in children. J Pediatr Orthop.1998;18:451Y456

Qidwai SA. Treatment of diaphyseal forearm fractures in children by intramedullary Kirschner wires. J Trauma Inj Infect Crit Care. 2001;50(2):303Y307.

Fernandez FF, Egenolf M, Carsten C, et al. Unstable diaphyseal fractures of both bones of the forearm in children: plate fixation versus intramedullary nailing. Injury.2005;36:1210Y1216.

Kucukkaya M, Kabukcuoglu Y, Tezer M, et al. The application of open intramedullary fixation in the treatment of pediatric radial and ulnar shaft fractures. J Orthop Trauma. 2002;16(5):340Y344.

Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990;10:705-12.

Grace TG, Eversmann WW Jr. Forearm fractures: treatment by rigid fixation with early motion. J Bone Joint Surg Am. 1980; 62(3):433-8.

Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am. 2008;33:1911–1923.

Calder PR, Achan P, Barry M (2003) Diaphyseal forearm fractures in children treated with intramedullary fixation: outcome of K-wire versus elastic stable intramedullary nail. Injury 34(4):278–282

Creasman C, Zaleske DJ, Ehrlich MG. Analyzing forearm fractures in children: the more subtle signs of impending problems. Clin Orthop Relat Res. 1984; 188:40-53.

Metaizeau JP, Ligier JN. Le traitement chirurgical des fractures des os longs chez l'enfant. Interférences entre l'ostéosynthèse et les processus physiologiques de consolidation. Indications thérapeutiques [Surgical treatment of fractures of the long bones in children. Interference between osteosynthesis and the physiological processes of consolidation. Therapeutic indications]. J Chir (Paris). 1984 Aug-Sep;121(8-9):527-37. French. PMID: 6501457.

Prommersberger K J, Froehner S C, Schmitt R R, Lanz U B. Rotational deformity in malunited fractures of the distal radius. J Hand Surg Am 2004; 29: 110-5.

Lascombes P, Prevot J, Ligier JN, J.P. Metaizeau and T. Poncelet. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 caese. J PediatrOrthop. 1990;10:167-171

(Patel A, Li L, Anand A. Systematic review: functional outcomes and complications of intramedullary nailing versus plate fixation for both-bone diaphyseal forearm fractures in children. Injury. 2014 Aug;45(8):1135-43. doi: 10.1016/j.injury.2014.04.020. Epub 2014 May 2. PMID: 24845408.)

Zhao L, Wang B, Bai X, Liu Z, Gao H, Li Y. Plate Fixation Versus Intramedullary Nailing for Both-Bone Forearm Fractures: A Meta-analysis of Randomized Controlled Trials and Cohort Studies. World J Surg. 2017 Mar;41(3):722-733. doi: 10.1007/s00268-016-3753-1. PMID: 27778077).

Brooker B, Harris PC, Donnan LT, Graham HK. Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children. J Child Orthop. 2014;8(4):353-357. doi:10.1007/s11832-014-0605-0

Acharya BM, Devkota P, Thakur AK, Gyawali B. Intramedullary Flexible Nailing for Diaphyseal Fractures of Forearm Bones in Children. Rev Bras Ortop (Sao Paulo). 2019;54(5):503-508. doi:10.1055/s-0039-1693742

Fernandez FF, Eberhardt O, Langendörfer M, Wirth T. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B. 2009 Nov;18(6):289-95. doi: 10.1097/BPB.0b013e32832f5b20. PMID: 19623087.

Kruppa C, Bunge P, Schildhauer TA, Dudda M. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: A retrospective study of 202 cases. Medicine (Baltimore). 2017 Apr;96(16):e6669. doi: 10.1097/MD.0000000000006669. PMID: 28422876; PMCID: PMC5406092.