[Impact of buried versus exposed flexible intramedullary nails osteosynthesis on pediatric forearm fractures]

In elastic stable intramedullary nailing (ESIN), there are different opinions among surgeons on whether to leave the nail buried in the same arm or to leave it exposed.

To determine the risk of re-fracture in patients with a nail buried directly into the amr or left exposed as a treatment for forearm fractures, and to investigate postoperative complications.

The study included 113 pediatric patients with a forearm fracture of both diaphyses. Two groups were formed according to whether the nail was buried (Group B, n: 53) in the same arm or left exposed (Group E, n: 60). Data on the number of open reductions, the time to nail removal, the anesthesia type used for its removal, the number of re-fractures, skin infection, and nail entry site irritation were analyzed.

The mean union times between the groups were not significantly different (P = 0.371). The mean time of nail removal in group B (16.02 ± 1.29 weeks) was significantly longer than that of group E (6.65 ± 0.95 weeks) (P < 0.001). Open reduction rates were similar between groups (P = 0.401). The general anesthesia rate for nail removal in group B (77.4%) was significantly higher than group E (11.7%) (P < 0.001). The re-fracture rate was higher in patients who underwent open reduction in both groups (P < 0.001).

The results of this study demonstrated that, despite the increased infection rate, leaving the nail exposed did not increase the re-fracture rate, which was associated with open reduction.