Nancy Nail versus Intramedullary-wire Fixation of Pediatric Forearm Fractures

Author(s): Majed A and Baco AM

Source: J Pediatr Orthop B 2007; 16:129-132.

Summary:

Pediatric forearm fractures are common.  Recently, there has been an increase in the number of fractures treated by operative stabilization.  Surgical options include open reduction and plating and intramedullary nailing.  With regard to intramedullary nailing, the elastic nail has been the goal standard but K-wires remain another option.  Previous studies have reported a higher complication rate using K-wires when compared to elastic nail fixation.  The authors attempted to compare their cases of elastic nail fixation versus Kirschner fixation with regards to outcome and complications.  Only 23 children were included in the cohort.  All children with Galeazzi and Monteggia fractures were excluded.  The fractures involved either one or both bones.  Elastic nail fixation was used if available.  If not, Kirschner wire fixation was used with bending of the wires to achieve three-point fixation.  The intramedullary device was inserted in the radius and ulna.  The growth plate was avoided.  The wires were maintained for about four-months.  The demographics of the Kirschner wires and elastic nailing groups are similar with regard to age and fracture type.

The results of the study indicate little difference.  The union rate was 100%.  There was no difference in range of motion about the elbow or forearm segment.  There were a few cases of superficial infection but they did not appear to effect the ultimate outcome. This study demonstrates no difference in functional outcome between intramedullary Kirschner wire and elastic nailing.  However, the cohort is extremely small and larger numbers are necessary to make such a conclusion.  Therefore, these results should be taken with caution.  However, if elastic nails are not available, Kirschner wires remain a viable option.

Pediatric, Forearm, Fracture, Intramedullary, Nailing, Elastic

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