Synostosis after fracture of both forearm bones treated by intramedullary nailing.

This study evaluated the risk of radioulnar synostosis after fracture of both forearm bones at the same level. We hypothesized that (i) the incidence of synostosis in both-bone forearm fractures at the same level is low with intramedullary nailing (IMN); (ii) the type of fracture (open/closed) and type of reduction (open/closed) affect time to union. Seventy-eight patients who had been treated with IMN for fracture of both forearm bones and had at least 1 year of follow-up were included in the study retrospectively. All the patients were treated by IMN following closed reduction or open surgery. Patients were followed clinically and radiologically. Age, open or closed fracture, time to union, and occurrence of synostosis were documented. The mean age of the patients was 33.4 years. Fifty-three (68%) patients were male. Forty-eight (61.5%) patients had high velocity injuries. The mean follow-up was 26.4 (12-46) months. According to the Grace and Eversmann scoring system, 95% had good or excellent outcomes. The mean DASH score was 10.5 (0-56). Union rate was 100%. Only one patient (1.2%) had a radioulnar synostosis at middle third level. IMN is a safe method that yields a high union rate and contributes to a low incidence of synostosis. Open fracture and open reduction during surgery have no effect on time to union.

GUse of provisional K wires instead of Poller screws for treatment of diametaphyseal fractures of the distal femur and proximal and distal tibia.

There are several important technical points that need to be observed when using an intramedullary nail to fix diametaphyseal fractures of femur and tibia. We aimed to describe a technique using 3.0-mm K wires, which act like Poller screws, in conjunction with intramedullary nails to obtain alignment of diametaphyseal fractures of the femur and tibia, and present our results. 7 distal femoral, 2 proximal tibial, and 4 distal tibial diametaphyseal fractures who were treated with this technique were identified. There was no case of nonunion at the last follow-up. In all, 12 of the 13 patients had postoperative fracture angulation that was less than 5° degrees in the coronal and sagittal planes. K wires function essentially as a Poller screw for centralization of the nail and help to ensure reduction. Locking the nail in different directions, appropriate reduction can be maintained until the bone heals and there is no need for additional fixation material.