OTA 1997 Posters - Forearm Fractures

Intramedullary Nailing of Diaphyseal Forearm Fractures in Adults

Andrew H. Crenshaw, Jr., MD, Christopher C. Hasty, MD

Campbell Clinic-DeSoto, Southaven, Mississippi, USA

Purpose: The purpose of this study was to determine the efficacy of closed intramedullary nailing of forearm diaphyseal fractures in adults.

Materials and Methods: Between October of 1997 and September of 1996, 27 diaphyseal forearm fractures in 17 adults were treated with reamed Foresight® intramedullary nailing. Eighteen (67%) were both-bone forearm fractures, 7 (26%) were isolated ulnar fractures (2 Monteggia), and 2 (8%) were isolated raidal fractures. Eight (30%) of the 27 fractures were segmental. Closed nailing was performed on 17 (63%) fractures. Eight (30%) fractures required limited open reduction because of an inability to reduce the fracture and pass the reamer across the fracture site. Open reduction was performed through a limited approach with minimal periosteal stripping, and material saved from the reaming was used for bone grafting. Two fractures were open injuries.

Results: All 27 fractures healed in an average of 10.9 weeks. There were no infections, malunions, or failures of hardware. Of 11 patients who were available for follow-up range-of-motion testing, 9 had full range of motion in the elbow, forearm, and wrist; 2 patients lacked 20° and 50° of supination. Complications occurred in 3 patients. In 1, a reamer became incarcerated in the middle segment of a segmental radial fracture, resulting in complete periosteal stripping of that segment. In another patient, the volar cortex of the distal radius was perforated by the reamer. No permanent sequelae occurred in either patient. In the third patient, rotational control was lost in a proximal radial fracture because of the unavailability of a proximal locking screw of appropriate length.

Discussion: The current recommended treatment of both-bone forearm fractures, radial diaphyseal fractures, and displaced ulnar fractures in adults is rigid internal fixation. Plate and screw fixation, a commonly used method, requires extensive surgical exposure and periosteal stripping, which compromises vascular supply, increases operative morbidity, and increases the risk of refracture if hardware is removed. Intramedullary nailing offers a viable alternative to plate and screw fixation, providing an equal rate of union with the advantage of a less invasive procedure.

Conclusions: The results of this study indicate that closed intramedullary nailing is an excellent method of treatment of forearm fractures in adults, resulting in decreased operative morbidity, excellent healing rates, and maintenance of range of motion.