Pediatric Both Bone Fracture: Flexible Nails

Abstract

Forearm fractures in children are among the most common long bone injuries, which occur in about 1% of children annually, with a peak incidence in the early adolescent age group. Though most of these fractures can be treated with casting, with or without closed reduction, the orthopedic surgeon may indicate a patient for operative fixation with flexible intramedullary nailing in the setting of unacceptable malalignment, an unstable fracture, refracture, neurovascular compromise, or an open fracture. This type of fixation provides a three-point bending moment, which results in angular and longitudinal stability, particularly with mid-shaft fractures. When compared to plating, flexible intramedullary nailing results in similar reduction and union rates, functional outcomes, and with reduced operative time and blood loss, as well as increased ease of hardware removal. It is not without complications, however, which include skin irritation, extensor tendon injury, nerve injury, delayed union (more common in patients older than 10 years), nonunion, malunion, or refracture. With the appropriate indication and careful surgical technique, flexible intramedullary nailing provides a safe and reliable method of fixation for both bone forearm fractures in children.