Role of titanium elastic nails in open forearm fractures in adults: a feasible alternative

Traditional management of forearm fractures involves open reduction and internal fixation (ORIF) using plates and screws after wound healing. However, recent years have seen the emergence of minimally invasive techniques like titanium elastic nailing (TENS) as potential alternatives. This retrospective study evaluates the role of TENS in managing open forearm fractures in adults.

A retrospective analysis was conducted over 5 years, including 18 adult patients with open forearm fractures without neurovascular or tendon injury, classified as Gustilo Anderson III A and IIIB. Surgical management involved TENS insertion following debridement with patients undergoing general anaesthesia or brachial block. Patients were positioned supine, and reduction was performed under fluoroscopy. TENS nails were inserted into the radius and ulna, with appropriate sizing and positioning. Plastic surgical interventions were performed as necessary.

There were satisfactory outcomes in 14 patients, with four patients achieving excellent outcomes at 12-month follow-up. The radiological union was observed in 12 patients, while six required revision surgeries. Deep tissue infection occurred in two patients, managed with debridement and vacuum-assisted closure. No forearm shortening was observed, with average supination and pronation of 70° and 80°, respectively. No evidence of infection was noted at the last follow-up.

The study underscores the feasibility of TENS as an alternative to external fixation or ORIF in managing open forearm fractures. TENS provides a viable option, particularly in combined orthopaedic and plastic surgery management, offering satisfactory outcomes and allowing for subsequent plating if needed. Ultimately, treatment decisions should be individualised, weighing various factors to optimise patient care and outcomes.