Dinesh Kumar Tutika1, Vamsi Krishna Kurmana2, Deepak Chamalla3, Shanmukha Rao Gollapalli4 Ranganath Marthala5
BACKGROUND
Diaphyseal fractures of the forearm are one of the common fractures in the
paediatric population. Closed reduction and cast immobilisation remain the
standard treatment for paediatric diaphyseal forearm fractures owing to their
unique remodelling potential. The main concern of conservative management is
re-displacement of fracture in cast resulting in the unacceptable angular deformity
in the forearm. Intramedullary fixation with titanium elastic nails for paediatric
diaphyseal forearm fractures is becoming the trending surgical technique in those
cases that warrant surgical intervention. The purpose of this study was to evaluate
the functional outcome of the management of fracture of both bones forearm in
the older children with titanium elastic nailing system.
METHODS
This was a prospective study done among thirty patients aged 5 to 16 years
admitted to the Department of Orthopaedics at GEMS & Hospital, Ragolu,
Srikakulam with diaphyseal fractures of both bones forearm from September 2017
to September 2019. We treated the patients by closed / open reduction and
internal fixation with elastic stable intramedullary nailing. The patients were
followed-up for six months.
RESULTS
We evaluated the patients clinically and radiologically after surgery. We assessed
the outcome using modified Anderson’s AO criteria for forearm fractures extracted
from the international journal of current pharmaceutical and clinical research
functions. All fractures united at an average of 9.1 weeks without any delayed or
non-union. The results were excellent in 86.6 % of patients and good in 13.3 %
of patients without significant complications. There were minor complications in 6
patients (20 %).
CONCLUSIONS
Titanium elastic intramedullary nailing is a safe, effective and minimally invasive
surgical method for treatment of displaced both bones forearm diaphyseal
fractures in older children. This technique gives relative stability with a three-point
fixation principle resulting in secondary bone healing by promoting early callus,
ideal for early mobilisation. The technique offers several advantages, including
minimal incision, preservation of fracture haematoma, dynamic axial stabilisation,
and shorter hospitalisation.
