Flexible Intramedullary Nailing of Forearm Fractures at the Distal Metadiaphyseal Junction in Adolescents

Abstract

Background: The purpose of this study was to analyze the radiographic and functional outcomes of flexible intramedullary (IM) nailing in adolescent patients with forearm fractures at the diaphysis or at the metadiaphyseal junction (MDJ). Methods: We retrospectively reviewed the results of 40 patients who underwent IM nailing for pediatric forearm fractures. Thirty males and 10 females were followed for an average of 16 months (range, 12 to 20 months). Their average age was 11 years (range, 10 to 16 years). The average duration from the onset of trauma to surgery was 3.8 days (range, 1 to 36 days). Fracture sites were located at the MDJ of the radius in 8 patients (MDJ group) while 32 patients had middle-third fractures (D group). We assessed the magnitude and location of the maximum radial bow and range of movements. Functional outcomes were evaluated using Daruwalla criteria. Results: Open reduction was carried out in 8 cases. Union was achieved at an average of 8.3 weeks postoperatively. The results were classified as good in 38 and excellent in 2 according to Daruwalla criteria with restoration of forearm rotation. The mean angulation at the last follow-up was 1.8 degrees on the anteroposterior radiograph and 3.3 degrees on the lateral radiograph (MDJ group: 1.8 degrees and 2.1 degrees, respectively; D group: 1.9 degrees and 2.8 degrees, respectively). There was no significant difference in the mean angulation between the groups. The mean magnitude of maximal radial bow was 5.7% +/- 1.8% (MDJ group, 5.2% +/- 0.8%; D group, 5.9% +/- 1.9%). The mean location of maximal radial bow was 58.0% +/- 8.8% (MDJ group, 56.4% +/- 8.9%; D group, 58.6% +/- 8.9%). The differences in the mean magnitude and location of maximal radial bow with the normal contralateral arms (7.0% +/- 1.2% and 50.9% +/- 6.0%, respectively) were not significantly different between the groups. Complications included superficial infection (2), delayed union (1), and refracture (1). Conclusions: IM nail fixation provided satisfactory results and maintained adequate stability for both forearm bone fractures in adolescents, even though the fracture was located at the MDJ of the radius.