Flexible IM nailing for both-bone forearm fractures yielded fewer complications than ORIF in skeletally immature patients

Shah A. J Orthop Trauma. 2010;12(7):440-447. doi:10.1097/BOT.0b013e3181ca343b.

Results of a small series indicated that flexible intramedullary nailing of both-bone forearm fractures in adolescents was safe and effective.

In a retrospective, comparative study at a level I trauma center, Apurva S. Shah, MD, MBA, University of Michigan, Ann Arbor, and colleagues compared flexible intramedullary (IM) nailing with open reduction and internal fixation (ORIF) with plates and screws for treating adolescent both-bone forearm fractures.

The study included 61 skeletally immature adolescents who were operated on for both-bone forearm fractures from 1997 to 2007. Forty-six patients underwent ORIF, and 15 patients underwent flexible IM nailing. Mean patient age was 13.9 years. The researchers excluded patients with Monteggia, Galeazzi, intra-articular and pathologic fractures.

Shah and colleagues selected time to union, forearm rotation, magnitude and location of maximal radial bow and complications as the primary outcome measures.

Mean time to union was nearly identical for both groups: 8.5 weeks for IM nailing and 8.9 weeks for ORIF; however, this study lacked the power to detect a difference, the authors wrote.

Eighty-three percent of all patients in the study regained full forearm rotation. Although radial bow magnitude was restored to a similar level in both groups, flexible IM nailing resulted in a distal translation of the radial bow. Forearm rotation was not compromised, according to the researchers.

The IM nailing group had no major complications; there were 5 major complications in the ORIF group.

I think that this is a well-designed study with a good methodology. The authors hypothesized that no difference exists between ORIF and IM nailing with regard to time to union, restoration of the magnitude and location of radial bow, postoperative forearm rotation and complication rate. I do agree with the investigators’ conclusion that flexible IM nailing of both-bone forearm fractures in adolescents is safe and effective; however, as the authors have clearly stated in their work, this study does not have sufficient power to detect a difference in the mean time to union.

Overall, I believe this study has clinical impact; the findings probably do not radically change our care, but I think they will stimulate general pediatric trauma surgeons to search for options for better clinical and functional results.

– Ufuk Ozkaya, MD
Orthopaedics and Traumatology Department
Taksim Research and Education Hospital
Beyoðlu, Ýstanbul