Pre-bend elastic stable intramedullary nail fixation for distal radial shaft fractures in children

Objective To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. Methods From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years,with an average of 9 years and 8 months. All the cases were closed fractures, and followed up at least 12 months. The time interval from injury to surgery were 1 to 9 days. Fracture sites were located at the distal radial shaft. Among them, 15 cases suffered ipsilateral ulnar fracture, and the others for solitery radial fracture. Closed reductions were performed under C-arm fluoroscopy. All affected arms were immobilized in the functional position postoperatively by the plaster cast beyond elbows. Results The average time of fracture complete union was 5 months (ranged from 3 months to 7 months). The average preoperative angulation of the fractures: anteroposterior view 16.2±7.5 degrees, lateral view 26.2±13.1 degrees. The average postoperative angulation of the fractures: anteroposterior view 2.7±1.5 degrees, lateral view 1.4±1.2 degrees. All fractures maintained good alignment postoperatively, and 94.4% (17/18) of the patients regained a full range of rotation of the forearm. One patient suffered limitation of rotation in forearm less than 10°, and this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Conclusion Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children. Key words: Child; Radius fractures; Fracture fixation, intramedullary