Session V - Upper Extremity

*Complications of Trueflex Nailing in Forearm Fractures

Peter Schandelmaier, MD, Christian Krettek, Prof., MD, Orna Gruen, Harald Tscherne, Prof., MD

Hannover Medical School, Hannover, Germany

Biomechanical studies have shown that there is an inherited stability problem in fixing both bone forearm fracture (BBFX) by intramedullary trueflex nails (TFN). In single bone forearm fractures (SBFX) and fracture dislocations the biomechanical stability was in the range of plate osteosynthesis. Purpose of our study was to compare clinical results in a group of BBFX treated by TFN to a group of SBFX treated by TFN.

Material and Methods: From 32 cases of treatment by TFN 13 cases with a BBFX were treated by two TFN. Ten cases of SBFX were treated with a single TFN. Overall there were 13 BBFX, 2 fractures of the shaft of the radius, 4 Galeazzi fractures, 3 isolated fractures of the shaft of the ulna and 1 Monteggia lesion. Two patients with 3 fractures died due to injury-related causes. From the remaining 20 cases, 18 were followed at least to 6 months postop. According to the OTA Classification, the 2 groups included 5 A fractures, 16 B fractures and 2 C fractures. Seven fractures were open. Five cases had additional injuries to the same upper extremity and 5 cases were polytraumatized patients.

Results: Average operative time was 48.8 ± 15.8 min. in the SBFX group and 91.2 ± 48.7 min. in the BBFX group. Especially reduction of the ulna fracture was difficult to achieve, even with percutaneous technique, in 6 cases an open reduction had to be done. Out of 13 BBFX we had 9 cases of delayed healing. Of these cases Reosteosynthesis due was done in 4 cases, the others went on to uneventful union. At follow up we had 1 cross-union and 4 cases with severely limited forearm rotation.

Discussion: TFN of both bone forearm fractures showed a high incidence of reduction problems resulting in a long operative time. Open reduction due to this problem had to be done in 6/13 cases. BBFX showed a high incidence of delayed union especially of the ulna. In SBFX reduction was not the problem, there was no delay in bony healing.

Conclusions: TFN of both bone forearm fractures cannot be recommended as a standard treatment. In single bone forearm fractures TFN showed good results and can be recommended.

	SBFX n=10	BBFX n=13
Extension of Fx	1	4
Radius percutaneous reduction	0	2
Open reduction	0	1
Ulna percutaneous reduction	2	3
Open reduction	0	6
Ulna time to bony healing >4M	0	6
Ulna time to bony healing >8M	0	2
Radius time to bony healing >4 M	0	9
Radius time to bony healing >8M	0	0
Reosteosynthesis	0	4
Crossunion	0	1
Decreased forearm rotation	0	4