Healing smarter: A systematic review and meta-analysis of bioresorbable implants for paediatric forearm fractures
Florence Eastwood1, Firas Raheman1, Ghaith Al-Dairy1
1Mid and South Essex NHS Foundation Trust, Chelmsford, UK.
Insights
Bioabsorbable intramedullary nails provide a safe and effective alternative for paediatric forearm fractures, matching traditional methods without requiring implant removal. This approach offers comparable healing and complication rates, with improved functional outcomes for children.
Area of Science:
- Orthopaedic Surgery
- Biomaterials Science
- Paediatric Traumatology
Background:
- Paediatric forearm fractures are common, with diaphyseal fractures often needing surgical intervention.
- Conventional treatments like elastic stable intramedullary nailing (ESIN) necessitate secondary removal procedures.
- Bioabsorbable intramedullary nails present a promising alternative, potentially reducing healthcare burdens by avoiding implant removal.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of bioabsorbable intramedullary nails versus conventional methods for paediatric forearm fractures.
- To compare fracture healing times, complication rates, and functional outcomes between the two treatment modalities.
Main Methods:
- A systematic review and meta-analysis of five studies involving 255 paediatric patients and 399 forearm fractures.
- 159 fractures were treated with bioabsorbable intramedullary nails.
- Outcomes assessed included fracture healing duration, complications, functional results, and reoperation rates.
Main Results:
- Bioabsorbable intramedullary nails showed comparable fracture healing times to ESIN (10.67 weeks).
- Complication rates and secondary displacement were similar between groups.
- Improved pronation and elbow flexion were observed with bioabsorbable nails, alongside comparable pain scores and fewer reports of postoperative pain.
Conclusions:
- Bioabsorbable intramedullary nails are a safe and effective alternative to ESIN for paediatric forearm fractures.
- Equivalent clinical outcomes are achieved, with the added benefit of eliminating implant removal.
- Further large-scale, long-term studies are recommended to confirm findings and assess cost-effectiveness.
Purpose:
Paediatric forearm fractures are among the most common childhood injuries, with diaphyseal fractures often requiring surgical management due to their instability and poorer remodelling potential. Traditional methods, such as elastic stable intramedullary nailing, are effective but require secondary procedures for implant removal, increasing healthcare burdens. Bioabsorbable intramedullary nails offer an alternative, eliminating the need for implant removal. This systematic review and meta-analysis evaluates the efficacy and safety of bioabsorbable intramedullary nails compared to conventional methods.
Methods:
Five studies, including 255 paediatric patients with 399 forearm fractures, were included. Of these, 159 were treated with bioabsorbable intramedullary nails. Meta-analyses assessed outcomes, including fracture healing time, complications, functional results and reoperation rates.
Results:
Bioabsorbable intramedullary nails demonstrated fracture healing times comparable to elastic stable intramedullary nailing (10.67 weeks; 95% CI: 8.92-11.42) with no significant differences. Complication rates were similar, with nine re-fractures in the bioabsorbable intramedullary nail group and 10 in the elastic stable intramedullary nailing group. Secondary displacement occurred in 3.1% of bioabsorbable intramedullary nail patients versus 4.7% for elastic stable intramedullary nailing. Functional outcomes showed improved pronation (78.5° versus 72.7°, p = 0.030) and elbow flexion (153.8° versus 144.8°, p = 0.001) for bioabsorbable intramedullary nails. Pain scores were comparable, with fewer bioabsorbable intramedullary nail patients reporting postoperative pain.
Conclusions:
Bioabsorbable intramedullary nails are a safe and effective alternative to elastic stable intramedullary nailing, offering equivalent clinical outcomes while eliminating the need for implant removal. Larger, long-term studies are needed to confirm these findings and evaluate the cost-effectiveness of bioabsorbable intramedullary nails in paediatric fracture management.
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