[Elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm fractures in the child: about 87 cases]

Saad Andaloussi, Mohamed Amine Oukhouya, Othmane Alaoui, Karima Atarraf, Lamiae Chater, My Abderrahmane Afifi, Saad Andaloussi, Mohamed Amine Oukhouya, Othmane Alaoui, Karima Atarraf, Lamiae Chater, My Abderrahmane Afifi

Abstract

This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Nailing was promptly performed in 50 cases and after secondary displacement during plaster-cast treatment in the other cases. Both bones were nailed in all cases. All patients underwent systematic plaster immobilization for a period of about one month. On average, nails were removed after about 6 months. Functional outcomes were studied over a mean follow-up period of 10 months. Complications were marked by 14 superficial infections (14 cases), osteitis associated with material (2 cases), refracture (3 cases), pseudarthrosis (3 cases), delayed fracture consolidation (2 cases) and proximal radioulnar synostosis (1 case). Although intramedullary nailing ideally is an osteosynthesis technique suitable for the treatment of fractures in children, it is more invasive than orthopaedic treatment.Indications for treatment should remain within well-established limits.

Keywords: Fracture; child; elastic stable intramedullary nailing; forearm.

Figures

Figure 1
Figure 1
Migration de la broche cubitale
Figure 2
Figure 2
Ostéite
Figure 3
Figure 3
(A) Pseudarthrose du radius; (B) ostéosynthèse par plaque; (C) radio après 8 mois
Figure 4
Figure 4
Retard de consolidation du cubitus après 6 mois

References

    1. Amit Y, Salai M, Chechik A, Blankstein A, Horoszowski H. Closing intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence: a preliminary report. J Pediatr Orthop. 1985 Mar-Apr;5(2):143–6.
    1. Richter D, Ostermann P, Ekkernkamp A, Muher G, Hann MP. Elastic intra-medullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop. 1998 Jul-Aug;18(4):457–61.
    1. Métaizeau JP. L'ostéosynthèse chez l'enfant par embrochage centromédullaire élastique stable. Sauramps Médical, Montpellier. 1988;76(B):778–88.
    1. Karger C, Dietz JM, Keckel T, De Thomasson E, Briot B. Devenir des cals vicieux diaphysaires de l'avant-bras de l'enfant : à propos de 108 fractures traitées par méthode orthopédique. Rev Chir Orthop. 1986;72(Suppl 2):44–7.
    1. Zujovic J, Carlioz H. Le devenir des cals vicieux angulaires et les perturbations de la croissance longitudinales au décours des fractures diaphysaires chez l'enfant. EMC, Paris Appareil locomoteur. 1979;B(10):3–14031.
    1. Cullen MC, Roy DR, Giza E, Crawford AH. Complications of intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop. 1998 Jan-Feb;18(1):14–21.
    1. Schmittenbecher PP, Fitze G, Gödeke J, Kraus R, Schneidmüller D. Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop. 2008 Apr-May;28(3):303–6.
    1. Ballal MS, Garg NK, Bruce CE, Bass A. Nonunion of the ulna after elastic stable intramedullary nailing for unstable forearm fractures: a case series. J Pediatr Orthop B. 2009 Sep;18(5):261–4.
    1. Prévot J, Lascombes P, Guichet JM. Elastic stable intra-medullary nailing of forearm fractures in children and adolescent. Orthop Trans. 1995;18:1265–6.
    1. Simanovsky N, Tair MA, Simanovsky N, Porat S. Removal of flexible titanium nails in children. J Pediatr Orthop. 2006 Mar-Apr;26(2):188–92.
    1. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26:827–34.
    1. Ogonda L, Wong-Chung J, Wray R, Canavan B. Delayed union and non-union of the ulna following intramedullary nailing in children. J Pediatr Orthop. 2004 Sep;13(5):330–3.
    1. Lidder S, Heidari N, Amerstorfer F, Grechenig S, Weinberg A. Median Nerve Palsy following Elastic Stable Intramedullary Nailing of a Monteggia Fracture: an Unusual Case and Review of the Literature. Case Report Med. 2011;682454:1687–9627.
    1. Lascombes P. Fracture des deux os de l'avant-bras chez l'enfant et l'adolescent. Conférences d'enseignement 2008.; Elsevier Masson SAS..2008.
    1. Yalcinkaya M, Dogan A, Ozkaya U, Sokucu S, Uzumcugil O, Kabukcuoglu Y. Clinical results of intramedullary nailing following closed or mini open reduction in pediatric unstable diaphyseal forearm fractures. Acta Orthop Traumatol Turc. 2010;44(1):7–13.
    1. Bochang C, Katz K, Weigl D, Jie Y, Zhigang W, Bar-On E. Are frequent radiographs necessary in the management of closed forearm fractures in children? J Child Orthop. 2008;2(3):217–20.
    1. Don S. Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Pediatr Radiol. 2004;34(Suppl 3):S167–72. (discussion S234-41)
    1. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O. Failures and complications in intramedullary nailing of children's forearm fractures. J Child Orthop. 2010;4(2):159–67.
    1. Lobo-Escolar A, Roche A, Bregante J, Gil-Alvaroba J, Sola A, Herrera A. Delayed union in pediatric forearm fractures. J Pediatr Orthop. 2012;32(1):54–7.
    1. Fernandez FF, Eberhardt O, Langendörfer M, Wirth T. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B. 2009;18(6):289–95.
    1. Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 2010;30(4):313–9.
    1. Celebi L, Muralti HH, Dogan O, Yagmurlu MF, Aksahin E, Bicimoglu A. The results of intramedullary nailing in children who developed redisplacement during cast treatment of both-bone forearm fractures. Acta Orthop Traumatol Turc. 2007;41(3):175–82.
    1. Lee S, Nicol RO, Stott NS. Intramedullary fixation for pediatric unstable forearm fractures. Clin Orthop Relat Res. 2002;84(3):413–7.
    1. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26(6):827–34.
    1. Altay M, Aktekin CN, Ozkurt B, Birinci B, Ozturk AM, Tabak AY. Intramedullary wire fixation for unstable forearm fractures in children. Injury. 2006;37(10):966–73.

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