ABSTRACT
Diaphyseal forearm fractures in children are extremely common. They are mostly treated by conservative methods. The elastic intramedullary nail is a good solution owing to its advantages in the cases when surgery is needed
A total of 154 children with a forearm double fracture, who were surgically treated with the titanium elastic nail at the Department of Orthopedics, Erzurum Regional Training and Research Hospital between January 2010 and December 2015, were included in the study. Children aged more than 14 years with pathologic fractures, isolated radius, and isolated ulna fracture were excluded from the study. All cases were followed up for 1 year. All cases were treated first with closed reduction and casting. A surgical decision was taken for the cases that could not be reduced and had a shift in the fracture line in the follow-ups
The average union was radiologically for 5.9 weeks [4-9]. Pin tract infection was observed in two cases, skin irritation in seven cases, nail migration three cases, and refracture six cases. Nerve damage, tendon rupture, malunion, nonunion, and synostosis were not observed. Perfect results were obtained in 126 [82.7%] cases, and good results were obtained in 26 [15.9%] cases in the study
Elastic intramedullary nailing is a surgical technique primarily preferred for forearm fractures in children because it is easily applicable; is associated with a small incision and no need for a secondary operation; has a low complication risk; and yields good clinical and radiological results
ABSTRACT
This study aimed to present the case of a patient with distal tibia metaphysis extra-articular fracture accompanying soft tissue defect. A 19-year-old patient who fell from a horse 3 h ago was evaluated in the emergency department of a tertiary trauma hospital. He had left tibia distal metaphysis extra-articular fracture with a wound of 5 × 3.5 cm2on the medial side of the supramalleolar region. The wound was mechanically cleansed and covered with sterile dressings. A long leg splint was applied. Medical treatment including antibiotic therapy and tetanus prophylaxis was immediately started. Distally wedged tibial nailing fixation and interlocking using distal supportive bolt locking screw of the nailing system were performed. The screw surface was covered with available soft tissues of the wound. The treatment was continued using the vacuum-assisted closure system. Next, soft tissue reconstruction was done using the Yin-Yang flap. Two months later, a dynamization procedure was performed on the patient, whose soft tissue defect was resolved. His fracture healed in the postoperative fifth month. The wound was stable in the postoperative 13[th] month. All inserted implants were removed on the patient's request, and treatment was successfully completed. Distal supportive bolt locking screw was inserted most distally and covered with available soft tissue to stabilize distal tibial metaphyseal extra-articular fracture accompanying soft tissue defect in the supramalleolar region. Possible infections due to the exposure of distal interlocking screws of standard nailing fixation were prevented. A powerful fixation was achieved using the aforementioned nailing system. This fixation system not only created quite stable fixation to restore osseous pathology, but also could create a suitable environment to resolve soft tissue defect via proper treatment options and strategies