Functional outcome in adults treated for both bone forearm fractures with intramedullary square nails

Vidisha S. Kulkarni; Utkarsh K. Vishwakarma; Sunil G. Kulkarni

doi:10.18203/issn.2455-4510.IntJResOrthop20251806

Authors

Vidisha S. Kulkarni Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India https://orcid.org/0009-0004-0557-2996
Utkarsh K. Vishwakarma Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India https://orcid.org/0009-0001-6906-0867
Sunil G. Kulkarni Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India https://orcid.org/0000-0003-3444-9976

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251806

Keywords:

Both bones forearm fracture, Intramedullary square nails, Anderson’s criteria

Abstract

Background: The forearm fractures are considered intraarticular due to functional characteristics and spatial orientation. These fractures require anatomic reduction to maintain axial and rotational stability and preserve bone length with absolute stability for adequate healing to restore function. Open reduction and internal fixation is accepted as the treatment of choice for both bone forearm fractures according to many studies. However, it can result in complications like extensive soft tissue damage, evacuation of fracture hematoma, periosteal damage, radioulnar synostosis, neurovascular injury, compartment syndrome, delayed union, non-union, infection, refracture after implant removal. Intramedullary nailing is an alternative technique to avoid the above problems, with the advantages of minimal incision, no periosteal stripping, faster healing and biologic fixation. This study evaluates the functional outcome in adults treated for both bone forearm fractures with intramedullary square nail fixation at our institute.

Methods: 113 patients with closed both bone forearm fractures were treated with Intramedullary square nail fixation between January 2014 to December 2023. There were 54 (22A) type fractures, 44 (22B) type fractures, 15 (22C) type fractures. Functional outcome was assessed based on Anderson’s criteria.

Results: 105 patients had excellent to satisfactory results while fixation in 8 patients resulted in failures based on Anderson’s criteria.

Conclusions: Intramedullary nailing is a simple, safe and effective method of alternative fixation of both bone forearm fractures that is associated with closed reduction, early union, biologic fixation, low infection rate, small cosmetic scars, less blood loss, shorter operating time, and less risk of compartment syndrome.

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References

Kurupati RB, Anil V, Reddy AK, Pillay DK, Sujai S, Shridhar S. Evaluation of the functional outcome of surgical management of both bones forearm fracture with locking compression plate: A prospective study. Int J Orthop Sci. 2021;7(4):30-3. DOI: https://doi.org/10.22271/ortho.2021.v7.i4a.2862

Ambhore N, Babhulkar S. A comparative study between plating & intramedullary nailing for displaced diaphyseal fractures of radius and ulna in adults. Surgical Update: Int J Surg Orthop. 2018;4(1):29-36. DOI: https://doi.org/10.17511/ijoso.2018.i01.06

Garampalli A, Panegaon N, Narasangi S. Comparative study of closed intramedullary elastic nailing vs plate osteosynthesis in diaphyseal fractures of both bones forearm in adults. Int J Orthop Sci. 2018;4(4):28-31. DOI: https://doi.org/10.22271/ortho.2018.v4.i4a.07

Box MW, Stegelmann SD, Domingue GA, Wells ME, Werthmann NJ, Potgieter CJ, et al. Intramedullary nail fixation versus open reduction and internal fixation for treatment of adult diaphyseal forearm fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19:719. DOI: https://doi.org/10.1186/s13018-024-05158-0

Kim DH, Jang HS, Kwak SH, Jung SY, Jeon JM, Ahn TY, et al. Surgical outcomes of segmental diaphyseal forearm fractures in adults: a small case series on plate osteosynthesis, intramedullary nailing, and other surgical methods. BMC Musculoskelet Disord. 2023;24:731. DOI: https://doi.org/10.1186/s12891-023-06857-1

Agrawal PP, Mankar S, Harkare VV, Sakhare RH, Halmare N. Functional Outcome of Forearm Fractures Managed With Screw Nails vs. Dynamic Compression Plates: A Prospective Study. Cureus. 2024;16(8):e67575. DOI: https://doi.org/10.7759/cureus.67575

Gadegone W, Salphale YS, Lokhande V. Screw elastic intramedullary nail for the management of adult forearm fractures. Indian J Orthop. 2012;46(1):65-70. DOI: https://doi.org/10.4103/0019-5413.91637

Zhang XF, Huang JW, Mao HX, Chen WB, Luo Y. Adult diaphyseal both-bone forearm fractures: A clinical and biomechanical comparison of four different fixations. Orthop Traumatol Surg Res. 2016;102(3):319-25. DOI: https://doi.org/10.1016/j.otsr.2015.11.019

Lari A, Hassan Y, Altammar, Esmaeil A, Altammar A, Prada C, et al. Interlocking intramedullary nail for forearm diaphyseal fractures in adults—A systematic review and meta-analysis of outcomes and complications. J Orthop Traumatol. 2024;25:16. DOI: https://doi.org/10.1186/s10195-024-00761-7

Köse A, Aydın A, Ezirmik N, Topal M, Can CE, Yılar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulus Travma Acil Cerrahi Derg. 2016;22(2):184-91. DOI: https://doi.org/10.5505/tjtes.2015.87036

Azboy I, Demirtaş A, Alemdar C, Gem M, Uzel K, Arslan H. A Newly Designed Intramedullary Nail for the Treatment of Diaphyseal Forearm Fractures in Adults. Indian J Orthop. 2017;51(6):697-703. DOI: https://doi.org/10.4103/ortho.IJOrtho_79_16

Kumar A, Khan R, Dushyant Chouhan, Arora R, Kumar S, Jameel J. Comparative study between hybrid fixation and dual plating in the management of both bone forearm fractures involving proximal half of radial shaft in adult patients. J Bone Joint Dis. 2020;35(2):19-9. DOI: https://doi.org/10.13107/jbjd.2020.v35i02.016

Sandeep SVS, Kakumanu RK. Management of fracture both bones forearm with plating/medullary nailing: A comparative study. Int J Orthop Sci. 2021;7(1):625-30. DOI: https://doi.org/10.22271/ortho.2021.v7.i1j.2552

Lil NA, Makkar DS, Aleem AA. Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures. Malays Orthop J. 2012;6(3):7-12. DOI: https://doi.org/10.5704/MOJ.1207.013

Sreejith GS, Gunaki RB, Kishor S, Gautam SV, Tailor D. A comparative study of both bone forearm fractures treated with intramedullary nailing vs plating in adults. Int J Orthop Sci. 2019;5(2):881-5. DOI: https://doi.org/10.22271/ortho.2019.v5.i2m.103

Prasad R, Manjhi LB. Evaluation of outcome of fracture of adult diaphyseal forearm bones treated by nailing and plating. Int J Orthop Sci. 2020;6(3):873-80. DOI: https://doi.org/10.22271/ortho.2020.v6.i3m.2297

Naser A, Patel DG, Vare DS, Patel DM. A study of functional outcome of fracture both bonesforearm in adults treated with locking compression plate. IOSR J Dent Med Sci. 2021;20(7):27-34.

Saini R, Sharma A, Baisoya K, Ravalji D. A Comparative Study Between Plate Osteosynthesis and Intramedullary Nailing for Diaphyseal Fracture of Radius and Ulna in Adults. Cureus. 2023;15(4):e37277. DOI: https://doi.org/10.7759/cureus.37277

Goldfarb CA, Ricci WM, Tull F, Ray D, Borrelli J. Functional outcome after fracture of both bones of the forearm. J Bone Joint Surg Br. 2005;87-B(3):374-9. DOI: https://doi.org/10.1302/0301-620X.87B3.15509

Kim BS, Lee YS, Park SY, Nho JH, Lee SG, Kim YH. Flexible Intramedullary Nailing of Forearm Fractures at the Distal Metadiaphyseal Junction in Adolescents. Clin Orthop Surg. 2017;9(1):101-8. DOI: https://doi.org/10.4055/cios.2017.9.1.101

Street DM. Intramedullary forearm nailing. Clin Orthop Relat Res. 1986;(212):219-30. DOI: https://doi.org/10.1097/00003086-198611000-00023

Sage FP. Medullary Fixation of Fractures of the Forearm: A Study of the Medullary Canal of the Radius and a Report of Fifty Fractures of the Radius Treated with a Prebent Triangular Nail. J Bone Joint Surg. 1959;41:1489-525. DOI: https://doi.org/10.2106/00004623-195941080-00010

Talwalkar AK, Talwalkar OA. Treatment of simple fracture of radius and ulna with internal fixation without external support. Indian J Orthop. 1967;1(1):26-30.

Rush LV, Rush HL. Evolution of medullary fixation of fractures by the longitudinal pin. Arm J Surg. 1949;78:324-33. DOI: https://doi.org/10.1016/0002-9610(49)90350-5

Köse A, Aydın A, Ezirmik N, Yıldırım ÖS. A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures. Ulus Travma Acil Cerrahi Derg. 2017;23(3):235-44. DOI: https://doi.org/10.5505/tjtes.2016.66267

Lee SK, Kim KJ, Lee JW, Choy WS. Plate osteosynthesis versus intramedullary nailing for both forearm bones fractures. Eur J Orthop Surg Traumatol. 2014;24(5):769-76. DOI: https://doi.org/10.1007/s00590-013-1242-x