Objectives: We assessed the results of intramedullary nailing in children who developed redisplacement during cast treatment of both-bone forearm fractures.
Methods: Twenty-eight children (19 boys, 9 girls; mean age 10.6 years; range 8 to 15 years) were treated with intramedullary fixation upon failure of initial reduction of both-bone forearm fractures after a mean of four weeks (range 3 to 6 weeks) of cast treatment. Intramedullary fixation was performed following closed (n=20) or open (n=8) reduction using K-wires in the first 10 cases, and titanium elastic nails in 18 cases. Single bone fixation was possible in four (14.3%) cases. For malunion assessment, the amount and location of the maximum radial bow were measured and compared with the normal side and with corresponding extremities of age-matched controls. Functional results were assessed using the Grace-Eversmann criteria. The mean follow-up was 14 months (range 12 to 18 months).
Results: Except for a nonunion of the ulna in one patient who underwent single bone fixation, all correction losses could be restored to normal alignment and united within a mean of seven weeks (range 6 to 8 weeks). The amount and location of the maximum radial bow did not differ significantly from those of the normal side and control extremities (p>0.05). Functional results were excellent in 25 patients (89.3%), good in two patients (7.1%), and unacceptable in one patient (3.6%). None of the patients developed infection, neurapraxia, or after removal of the nail, angulation, refracture, or extremity length discrepancy.
Conclusion: Intramedullary fixation for correction losses during cast treatment of both-bone forearm fractures is a safe and inexpensive treatment, allowing early mobilization and providing excellent anatomic and functional results.