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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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Refractures of the paediatric forearm with the intramedullary nail in situ

Pim W van Egmond1, Hans A van der Sluijs, Barend J van Royen

  • 1Department of Orthopaedic Surgery, VU Medical Centre, Amsterdam, The Netherlands.

BMJ Case Reports
|September 27, 2013
PubMed

Insights

Pediatric forearm fractures treated with Elastic Stable Intramedullary Nailing (ESIN) can refracture. This study suggests closed reduction is a viable management option for these rare, but under-recognized, complications.

Area of Science:

  • Pediatric Orthopedics
  • Surgical Complications
  • Fracture Management

Background:

  • Diaphyseal forearm shaft fractures in children often require operative treatment when conservative methods fail.
  • Elastic Stable Intramedullary Nailing (ESIN) is a primary surgical choice for these fractures.
  • Refractures with the ESIN in situ are a known complication, yet management guidelines are scarce.

Observation:

  • A case of radius midshaft refracture in a 12-year-old boy with an in situ ESIN is presented.
  • A literature review identified 30 similar cases, analyzing their treatment and outcomes.
  • Refracture with ESIN in situ occurred in approximately 2.3% of the study population.

Findings:

  • Refracture of pediatric forearm fractures with the intramedullary nail in situ is a rare complication.
  • Closed reduction was successfully employed in the presented case.
  • Analysis of 30 similar cases supports closed reduction as a potential treatment strategy.

Implications:

  • This study highlights a rare but under-recognized complication in pediatric forearm fracture management.
  • The findings suggest that closed reduction can be a suitable treatment option for refractures with ESIN in situ.
  • A defined treatment strategy for this specific complication may improve patient outcomes.

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