Thurs., 10/8/09 Pediatrics & Injury Prevention, Paper #26, 2:41 pm OTA-2009
Elastic Stable Intramedullary Nailing in Pediatric Forearm Fractures: An Analysis of 162 Cases
(FDA = Non-U.S. research conducted within guidelines of my country)
Christian Schinkel, MD (n); Marcel Dudda, MD (n); Gert Muhr, MD (n);
Hamid Joneidi-Jafari, MD (n); Tobias Fehmer, MD (n); Alexandros P. Anstasiadis, MD (n);
University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
Purpose: Forearm fractures are the most common fractures of children and adolescence. In case of instability, unacceptable angular deformity, open fracture, or combination injuries like Monteggia or Monteggia-equivalent injuries, an operative treatment should be considered. In the last decade, elastic stable intramedullary nailing (ESIN) has been established as the state-of-the-art treatment. To evaluate the outcome of this technique, we analyzed retrospectively patients with pediatric forearm fractures treated with ESIN.
Methods: All patients under 16 years of age in the period from 2000 to 2008 treated with ESIN were included. Evaluation of treatment procedure, complications and problems, and final results after consolidation and ESIN removal was performed.
Results: 221 elastic stable intramedullary nails were implanted during the observation period. 162 of these were used in forearm fractures. Mean age at time point of trauma was 11 years. 98 fractures (60.5%) occurred on the left side, 62 (38.3%) on the right, and 2 (1.2%) were found bilateral. Postoperative clinical and radiological controls were performed in 128 cases (79%). Mean time to consolidation and nail removal was 16.7 weeks (range, 13-70 weeks; median, 12.4 weeks). No further consultation due to disorders was registered in these patients. Reosteosynthesis was necessary in 3 (2.3%) patients (60.5%). One patient (0.8%) suffered an ipsilateral forearm fracture 4 months after nail removal with ESIN redo after developing an adequate trauma.
Conclusion: We consider the ESIN as first-choice treatment in forearm fractures in children and adolescence if operative treatment is necessary. ESIN is minimally invasive, reliable and easy to use, has a low complication rate, and is combined with a high patient acceptance as it allows early postoperative exercise.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant