Pediatric forearm fractures with in situ intramedullary implants
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Brian A Kelly1, Benjamin J Shore1, Donald S Bae1
1Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
Insights
Pediatric forearm fractures with in situ intramedullary nails are rare but can be treated effectively. Various revision techniques, including rod removal or bending, lead to successful union.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Intramedullary nails are used for pediatric forearm fractures.
- Fractures occurring after initial healing but before implant removal are a rare complication.
Purpose of the Study:
- To present institutional experience with pediatric forearm fractures associated with in situ intramedullary nails.
- To analyze the incidence, treatment, and outcomes of this rare complication.
Main Methods:
- Retrospective review of six pediatric patients with forearm fractures and in situ intramedullary implants (2004-2013).
- Data collected included demographics, injury details, treatment methods, union time, and complications.
Main Results:
- Six cases (1.2%) of re-fracture with in situ implants were identified.
- All fractures occurred after radiographic healing but before implant removal.
- Treatment varied, including casting, rod revision, or plate fixation, with all patients achieving uncomplicated union.
Conclusions:
- Fractures of the pediatric forearm with in situ intramedullary implants are uncommon.
- Revision surgery, including rod revision or plate fixation, is effective.
- Successful and uncomplicated union can be expected with appropriate treatment.
Purpose:
The purpose of this investigation is to present our institutional experience with fractures of the pediatric forearm with in situ intramedullary nails.
Methods:
Six patients treated at our institution for forearm fracture with in situ intramedullary implants between 2004 and 2013 were reviewed. Patient demographics, injury and radiographic characteristics, method of treatment, time to union, and complications were collected from the medical record.
Results:
485 patients with forearm fractures were treated with intramedullary implants and six patients presented with a fracture with in situ implants (1.2 %). Fractures in all six patients resulted from a second traumatic event after radiographic healing but before implant removal at a mean of 13.0 months from the initial procedure. One patient had an adequately aligned fracture and was treated with casting without reduction. The remaining five patients (83 %) returned to the operating room for treatment. Two patients underwent rod removal and placement of new intramedullary implants, and two patients were treated with rod removal and plating without attempt at closed reduction. One patient underwent closed reduction in the operating room with successful re-bending of the radial implant and replacement of the ulna implant. All patients went on to uncomplicated radiographic union at a mean 3.6 months.
Conclusions:
The incidence of fracture of pediatric forearm with in situ intramedullary implants is low. This rare complication can be treated by several different methods, including revision TENS placement, revision to plate fixation, or in situ bending of rods, with the expectation for successful uncomplicated union.
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