Aims. To evaluate the results of Elastic Stable Intramedullary Nailing (ESIN) for displaced, unstable paediatric forearm diaphyseal fractures. Method. A retrospective, consecutive series study of 60 patients treated with ESIN between February 1996 and July 2005. Results. There were 43 (72%) boys and 17 (28%) girls with median age of 11.5 years (range: 2.6-15.9). 54 (90%) patients had a closed injury and 6 (10%) sustained a Grade I open injury. Seven patients had an isolated radius fracture. 49 (82%) fractures were stabilised with both bone ESIN, 10 (16%) with radial and one with isolated ulnar ESIN by standard technique under tourniquet control. All but two patients were protected with an above elbow cast. Thirty-six cases (60%) were primary procedures and 24 (40%) were performed due to re-displacement following a MUA. 36 patients (60%) required a minimal open reduction. Average hospital stay was 1.8 days (1-8 days). Average length of immobilisation was 5.4 weeks (3-9 weeks). Average time for clinical fracture union was 5.7 weeks (3-13 weeks). ESIN were removed after mean period of 33.8 weeks (approx: 7.9 months). One patient had a forearm compartment syndrome and required formal fasciotomy. One patient had ulnar delayed union and one had ulnar non-union. Five patients had transient superficial radial nerve neuropraxia. Ten had soft tissue irritation leading to early nail removal in two patients and two had superficial wound infection. Three patients sustained a re-fracture with the nail in situ following a new injury. 53 (88%) patients had full elbow and wrist movements on discharge. Seven patients had restriction of forearm rotations of less than 15°. Conclusion. Good clinical outcome, transitory and modest complications; quick and safe nail removal; and better cosmesis compared to plating makes ESIN an attractive treatment option for displaced, unstable paediatric forearm diaphyseal fractures

The management of displaced forearm diaphyseal fractures in adults is predominantly operative. Anatomical reduction is necessary to infer optimal motion and strength. The authors have observed an intraoperative technique where passive pronosupination is examined to assess quality of reduction as a surrogate marker for active movement. We aimed to assess the value of this technique, but intentionally malreducing a simulated diaphyseal fracture of a radius in a cadaveric model, and measuring the effect on pronosupination. A single cadaveric arm was prepared and pronation/supination was examined according to American Academy of Orthopaedic Surgeons guidance. A Henry approach was then performed and a transverse osteotomy achieved in the radial diaphysis. A volar locking plate was used to hold the radius in progressive amounts of translation and rotation, with pronosupaintion measured with a goniometer. The radius could be grossly malreduced with no effect on pronation and supination until the extremes of deformity. The forearm showed more tolerance with rotational malreduction than translation. Passive pronation was more sensitive for malreduction than supination. The use of passive pronosupination to assess quality of reduction is misleading

Out of a total of 112 children with displaced forearm shaft fracture treated with Percutaneous Kirschner (K) wire fixation in the past 9 years, 84 cases with fracture of both the radius and ulna were reviewed. 64 (76%) had fixation of both the radius and ulna, 10 (12%) the radius only and the other 10 (12%) the ulna only. In 60 (71%) patients were successful with one stage close reduction and pinning, while in the remaining 24 (29%) a semi- open reduction through a small incision was required. The K-wire was inserted through the radial styloid or the Lister tubercle for the radius, and through the tip of the olecranon for the ulna. All the patients reviewed were found to have good functional results with no non-union, deep infection or premature physeal closure at a mean follow-up of 48 months. Initial pre-operative shortening or translation of the fracture were associated with significantly higher chance of open reduction. We concluded that percutaneous K-wiring for forearm diaphyseal fracture in children is a convenient, effective and safe operation, with minimal complications

The type and the location of the fractures of the long bones in children that can be treated by elastic intra-medullary nailing are described in this study. Fourty-one patients (aged from 5–18 years old) were treated in our department with fractures of the long bones located on the metaphysis or diaphysis (5 on the distal third of radious and ulna ,8 diaphyseal fractures of the forearm ,7 diaphyseal fractures of the tibia ,5 of the distal end of tibia ,6 of the femoral diaphysis,7 on the distal end of femur and 3 on the diaphysis of the humerus). All operations were performed under radiological control ,to avoid any damage of the growth plates. Tibial , femoral and humeral fractures were fixed with 2 nails whereas forearm fractures were reducted with one nail. Postoperative immobilization with a long cast was applied in forearm fractures at least for 4 weeks. The follow-up time ranged from 1–3 years. The following clinical findings were noticed at the examination : skin infection at the point of the nail insertion area (3 patients), limitation of the range of movements at the carpal joint (2 patients). Radiological findings showed satisfactory callus formation at an early stage in all cases and rotational deformity in 2 femoral obligue fractures due to insufficient stabilization. According to our clinical and radiological findings the results were excellent in 34 cases and good in 7 cases. Fractures of the diaphysis or metaphysis of the long bones in children are fully indicated for intramedullary nailing with elastic nails and the postoperative complications are minor when the fractures are not close to the growth plates. The method is not indicated for comminuted or oblique fractures and fractures – separations