Technical aspects that may affect the outcomes of pediatric patients with both-bone forearm diaphyseal fractures...

Area of Science:

• Pediatric Orthopedics
• Traumatology
• Surgical Techniques

Background:

• Pediatric both-bone forearm diaphyseal fractures require effective treatment to ensure optimal functional and radiological outcomes.
• Elastic stable intramedullary nailing (ESIN) is a common surgical technique for these fractures, but factors influencing success require further investigation.

Purpose of the Study:

• To assess the radiological and functional results of pediatric both-bone forearm diaphyseal fractures treated with ESINs.
• To identify factors influencing treatment outcomes, including nail type, prebending, and the nail diameter to medullary canal diameter ratio (ND/MCD).

Main Methods:

• Retrospective analysis of 36 pediatric patients (mean age 11.6 years) treated with ESINs for both-bone forearm diaphyseal fractures.
• Evaluation of radiological outcomes including maximal radial bowing and functional results using established criteria (Price and Flynn).
• Measurement of the nail diameter to medullary canal diameter (ND/MCD) ratio and analysis of its correlation with outcomes.

Main Results:

• Excellent or good functional and radiological results were achieved in all 36 patients (100%).
• No nonunion or delayed union occurred. Titanium and stainless steel nails showed no significant difference in outcomes.
• Loss of reduction occurred in 4% of patients with an ND/MCD ratio below 40%. Maximal radial bowing improved significantly in all patients.

Conclusions:

• ESIN placement is an effective treatment for pediatric both-bone forearm diaphyseal fractures, with excellent radial bow remodeling.
• The ND/MCD ratio is a critical factor; a ratio between 40% and 70% is recommended to prevent loss of reduction.
• Nail type and prebending do not significantly impact functional or radiological outcomes in this patient cohort.