Intramedullary forearm nailing

Nailing of the forearm, beginning with Schöne, antedated nailing of the femur and tibia. Its slower development appears due to anatomic problems with the radius, the interdependence of the two bones, and the strong torque loads from the pronators and supinators. Kirschner wires, threaded Steinman pins, Küntscher U nails, and Rush pins were investigated extensively on fracture services before 1954 when a square-shaped nail to improve stability and fracture healing was designed. A broaching point, allowing some bite of the corners into the circumference of a reamed canal, provided better control of torque loads. Closed nailing has many advantages, including early union, low incidence of infection, small scars, less blood loss, and, frequently, relatively short operating time with minimal surgical trauma. Complications and pitfalls during surgery relate mainly to improper nail size and reaming technique. Open fractures led to the highest number of infections, and in highly comminuted fractures nonunion was occasionally seen. In a series of 137 nailed fractures, the nonunion rate was 7%. While the compression plates may give a slightly lower nonunion rate than nailing, the incidence was more than offset by the greater incidence of refractures and disfiguring scars.