Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for forearm fracture.Methods: The study included 173 patients (126 men and 47 women; median age: 11 years (range: 3-17 years) treated withESIN for forearm fracture between May 2002 and May 2018. Immobilization was not performed after the surgery. The median follow-up was 68 months (range: 3-161 months). The etiology, healing time, and complications were recorded.Results: All patients achieved complete radiographic healing at a median of 6.8 weeks (range: 4-11 weeks). The most common injuries were sport related (n=65) and by falling from standing height (n=57), followed by injuries from bicycle riding,motorbike accidents, road traffic accidents, and fights. Fifteen (8.76%) postoperative complications were recorded: eightentry-site skin irritations, two cases of skin infection, two refractures, and one case each of nail migration, injury of ulnarnerve, and pseudoarthrosis. All complications, except cases of refractures and pseudoarthrosis, were treated conservatively,with no long-term consequences for the patients. Patients with refractures and pseudoarthrosis were reoperated, and complete function of the extremities was fully restored.Conclusion: ESIN for treatment of forearm fractures in children shows good functional and cosmetic results. This is aminimally invasive, cast-free, simple, and reproducible technique, with a low complication rate. Owing to these excellentobjective and subjective results, surgical stabilization of the forearm fracture using ESIN is recommended in children andadolescents.
___
1. Antabak A, Luetic T, Ivo S, et al. Treatment outcomes of bothbone diaphyseal paediatric forearm fractures. Injury 2013; 44: 11-5. [Crossref]
2. Kruppa C, Bunge P, Schildhauer TA, Dudda M. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: A retrospective study of 202 cases. Medicine (Baltimore) 2017; 96: e6669. doi: 10.1097/ MD.0000000000006669. [Crossref]
3. Makki D, Matar HE, Webb M, Wright DM, James LA, Ricketts DM. Elastic stable intramedullary nailing in paediatric forearm fractures: the rate of open reduction and complications. J Pediatr Orthop B 2017; 26: 412-6. [Crossref]
4. Furlan D, Pogorelić Z, Biočić M, et al. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures. Scand J Surg 2011; 100: 208-15. [Crossref]
5. Peterlein CD, Modzel T, Hagen L, Ruchholtz S, Krüger A. Longterm results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children. Medicine (Baltimore) 2019; 98: e14743. doi: 10.1097/MD.0000000000014743. [Crossref]
6. Pogorelić Z, Kadić S, Milunović KP, Pintarić I, Jurić I, Furlan D. Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children: A retrospective series of 118 cases. Orthop Traumatol Surg Res 2017; 103: 765- 70. [Crossref]
7. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O. Failures and complications in intramedullary nailing of children’s forearm fractures. J Child Orthop 2010; 4: 159-67. [Crossref]
8. Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr 2014; 14: 314. doi: 10.1186/s12887- 014-0314-3. [Crossref]
9. Shah AS, Lesniak BP, Wolter TD, Caird MS, Farley FA, Vander Have KL. Stabilization of adolescent both-bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma 2010; 24: 440- 7. [Crossref]
10. Landin LA. Epidemiology of children’s fractures. J Pediatr Orthop B 1997; 6: 79-83. [Crossref]
11. Flynn JM, Waters PM. Single-bone fixation of both-bone forearm fractures. J Pediatr Orthop 1996; 16: 655-9. [Crossref]
12. Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques. J Pediatr Orthop 2005; 25: 309-13. [Crossref]
13. Pogorelić Z, Vodopić T, Jukić M, Furlan D. Elastic stable intramedullary nailing for treatment of pediatric femoral fractures; A 15-year single centre experience. Bull Emerg Trauma 2019; 7: 169-75. [Crossref]
14. Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting? J Child Orthop 2010; 4: 245-51. [Crossref]
15. Fiala MCT. Paediatric forearm fractures: an analysis of refracture rate. Orthop Trans 1994-1995; 18: 1265-6.
16. Gibbon E, Beranger JS, Bachy M, Deplont M, Kabbaj R, Vialle R. Influence of the bending of the tip of elastic stable intramedullary nails on removal and associated complications in pediatric both bone forearm fractures: A pilot study. Int J Surg 2015; 16: 19-22. [Crossref]
17. Schmidt CM, Mann D, Schnabel M. Elastic stable intramedullary nailing as alternative therapy for pediatric Monteggia fractures. Unfallchirurg 2008; 111: 350-7. [Crossref]
18. Pogorelić Z, Furlan D, Biočić M, Mestrović J, Jurić I, Todorić D. Titanium intramedullary nailing for treatment of simple bone cysts of the long bones in children. Scott Med J 2010; 55: 35-8. [Crossref]
19. Du SH, Feng YZ, Huang YX, Guo XS, Xia DD. Comparison of pediatric forearm fracture fixation between single- and double-elastic stableintramedullary nailing. Am J Ther 2016; 23: 730-6. [Crossref]
20. Nisar A, Bhosale A, Madan SS, Flowers MJ, Fernandes JA, Jones S. Complications of elastic stable intramedullary nailing for treating paediatric long bone fractures. J Orthop 2013; 10: 17-24. [Crossref]
21. Heare A, Goral D, Belton M, Beebe C, Trizno A, Stoneback J. Intramedullary implant choice and cost in the treatment of pediatric diaphyseal forearm fractures. J Orthop Trauma 2017; 31: 334-8. [Crossref]
22. Cullen MC, Roy DR, Giza E, Crawford AH. Complications of intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop 1998; 18: 14-21. [Crossref]
23. Slongo TF. Complications and failures of the ESIN technique. Injury 2005; 36: 78-85. [Crossref]