Flexible Intramedullary Nailing of Forearm Fractures at the Distal Metadiaphyseal Junction in Adolescents

BACKGROUND: The purpose of this study was to analyze the radiographic and functional outcomes of flexible intramedullary (IM) nailing in adolescent patients with forearm fractures at the diaphysis or at the metadiaphyseal junction (MDJ). METHODS: We retrospectively reviewed the results of 40 patients who underwent IM nailing for pediatric forearm fractures. Thirty males and 10 females were followed for an average of 16 months (range, 12 to 20 months). Their average age was 11 years (range, 10 to 16 years). The average duration from the onset of trauma to surgery was 3.8 days (range, 1 to 36 days). Fracture sites were located at the MDJ of the radius in 8 patients (MDJ group) while 32 patients had middle-third fractures (D group). We assessed the magnitude and location of the maximum radial bow and range of movements. Functional outcomes were evaluated using Daruwalla criteria. RESULTS: Open reduction was carried out in 8 cases. Union was achieved at an average of 8.3 weeks postoperatively. The results were classified as good in 38 and excellent in 2 according to Daruwalla criteria with restoration of forearm rotation. The mean angulation at the last follow-up was 1.8° on the anteroposterior radiograph and 3.3° on the lateral radiograph (MDJ group: 1.8° and 2.1°, respectively; D group: 1.9° and 2.8°, respectively). There was no significant difference in the mean angulation between the groups. The mean magnitude of maximal radial bow was 5.7% ± 1.8% (MDJ group, 5.2% ± 0.8%; D group, 5.9% ± 1.9%). The mean location of maximal radial bow was 58.0% ± 8.8% (MDJ group, 56.4% ± 8.9%; D group, 58.6% ± 8.9%). The differences in the mean magnitude and location of maximal radial bow with the normal contralateral arms (7.0% ± 1.2% and 50.9% ± 6.0%, respectively) were not significantly different between the groups. Complications included superficial infection (2), delayed union (1), and refracture (1). CONCLUSIONS: IM nail fixation provided satisfactory results and maintained adequate stability for both forearm bone fractures in adolescents, even though the fracture was located at the MDJ of the radius.

A Comparison of Overgrowth after Treatment for Pediatric Femoral Shaft Fractures: Flexible Intramedullary Nailing versus External Fixation / 대한정형외과학회잡지

PURPOSE: Overgrowth is a common complication after the treatment of pediatric femoral fractures. However, the effect of treatment methods on the overgrowth is controversial. We compared the amount of overgrowth between flexible intramedullary nailing and external fixation. MATERIALS AND METHODS: Twenty-six children with femoral diaphyseal fractures after a minimum 2 year follow-up were enrolled in this retrospective study. Thirteen patients were treated with flexible intramedullary nailing (FIN) group, and the other 13 patients were treated with external fixation (EF) group. The overgrowth of femur, clinical outcomes, and complications were evaluated. RESULTS: Union was obtained in all patients without major complications, except for overgrowth. Average overgrowth at the 2-year follow-up was 4 mm (-6-13 mm) in the FIN group, and 3 mm (-13-13 mm) in the EF group (p=0.532). Overgrowths of more than 10 mm were observed in four patients; three patients in the FIN group, and one in the EF group. CONCLUSION: FIN and EF showed similar amounts of overgrowth, after the treatment for pediatric femoral fractures.

Comparison of Flexible Intramedullary Nailing with External Fixation for Treating Pediatric Femoral Shaft Fractures / 대한정형외과학회잡지

PURPOSE: We wanted to compare the outcome of the flexible intramedullary nailing with that of external fixation for treating pediatric femoral shaft fractures. MATERIALS AND METHODS: Forty-two cases of pediatric femoral shaft fractures were reviewed of which thirty cases of femoral segments were treated with the flexible intramedullary nailing (the FIN group) and the other 12 cases were treated with the external fixation (the EF group). The average age of the patients was 6.9 years and the mean follow-up was 28.8 months. The clinical outcome and complications were evaluated. RESULTS: In all cases, the reduction was maintained until complete union. In the FIN group there were 20 excellent, 8 satisfactory and 2 poor results whereas there were 6 excellent, 4 satisfactory and 2 poor results in the EF group. Among the complications that required re-admission, there was one case of refracture and one case of deep infection in FIN group; one case of refracture, one case of pin breakage and three cases of deep infections in the EF group. CONCLUSION: Flexible intramedullary nailing may result in better clinical results and fewer complications when compared with the external fixation, and so the flexible intramedullary nailing may be the treatment of choice for the treatment of pediatric femoral shaft fractures, except for open fractures or fractures with severe soft tissue injury.

Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures / 대한정형외과학회잡지

PURPOSE: This study compared the results of external fixation with those of flexible intramedullary nailing using Ender nails in pediatric femoral shaft fractures. MATERIALS AND METHODS: Twenty-eight children with pediatric femoral shaft fractures were enrolled in the study. The children's ages ranged from 6 to 11 years, and the average period of follow-up was 27.2 months. Fifteen patients underwent flexible intramedullary nailing (FIN) using Ender nails and thirteen patients underwent external fixation (EF). The outcomes were assessed based on the clinical and radiology findings. RESULTS: The healing time averaged 9.8 weeks in the FIN group and 11.2 weeks in the EF group. In the FIN group, one patient suffered pin migration. In the EF group, three patients had a pin site infection, one patient had refracture after removing the external fixator and one patient had pin breakage 8 weeks after surgery. The broken pin was removed and the condition was stabilized with internal fixation using a plate. CONCLUSION: Flexible intramedullary nailing with Ender nails is an effective treatment option for treating femoral shaft fractures in children because it has fewer complications than external fixation does.

Treatment of Tibial shaft Fracture Using Flexible Intramedullary Nailing / 대한정형외과학회잡지

There are many controversies concering primary treatment of fractures of the tibial shaft. Recently, flexible intramedullary nailing for the tibial shaft fracture has gained popularity, because of promotimg osteogenesis with early weight bearing and preventing ankylosis of the joints. Authors carried out retrospective study of the 142 tibial shaft fractures in 141 patients, and results were as analyzed. The results were as follow:l. Among 141 patients, 116 cases were male and 25 cases were female. The average age was 37 years and the most cause of injury was traffic accident. 2. The number of cases of closed and open fractures were 71 cases, respectively. The most common type of the fracture was comminuted and the level was middle third. 3. The number nails were inserted from two to five according to width of the medullary cavity and to gain of the stability after reduction at the fracture site. 4. Average bone union in X-ray was 17.8 weeks, 96 cases were united within 20 weeks and 43 cases were united after 21 weeks. 5. Complications were 3 cases of non-union and 17 cases of valgus deformity, within 12 degrees.

Clinical Analysis of 122 Trochanteric Fractures of Femur Treated by Flexible Intramedullary Nailing / 대한정형외과학회잡지

Closed intramedullary nailing for trochanteric fractures of femur has many advantages such as minimal operative trauma, low incidence of infection, good stability of fracture, low incidence of delayed or nounion and early ambulation. Complications have been frequently experienced especially in elderly, osteoporotic patients, but these could be avoided by meticulous surgical procedure. The authors hsve treated 99 cases of intertrochanteric fracture and 23 cases of subtrochanteric fracture from March 1982 to December 1987 with this method and the results are summerized as follows : 1. The aversge age was 61.4 yrs. 2. In classification of intertrochanteric fracture, stable fractures(Kyle type I & II) were 53 cases(43.3%) and unstable fractures(Kyle type III & IV) were 46 cases(37.6%). And in subtrochanteric fracture, stable transverse fractures were 12 cases(9.8%) and unstable long oblique or spiral fractures were 11 cases(9.0%). 3. Intraoperative complications were experienced in 23 cases(18.8%). The entry hole breakage was most common and occurred in 16 cases. 4. Of the 94 patients with more than 6 months follow-up, 21 patients(22.3%) showed more than one complication, e.g, knee joint pain in 15 cases, external rotation deformity in 8 and nail migration in 11 including 3 cases of fixation loss and one case of nonunion with nail breakage, etc. 5. Complications occurred more frequently in unstable fractures(31.8%) and in old ages (29.1%) than in stable fractures and in young ages respectively. And it was felt that complications could be minimized by packing of the medullary canal with nails. 6. It is thought that flexible intramedullary nailing is a good method for trochanteric fractures of femur not only in elderly debilitated patients but also in young patients. However, experience and caution are required to prevent complications.