[Treatment of diametaphyseal forearm fractures in children and adolescents : Antegrade intramedullary nail osteosynthesis and its alternatives].

Abstract

Objective: Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load.

Indications: Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits.

Contraindications: Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path.

Surgical technique: In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3-4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a 2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. A titanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending.

Postoperative management: The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8 weeks. Metal removal can be performed after consolidation between 3 and 6 months.

Results: Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with a low risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred.