Functional outcome of elastic intramedullary nailing of forearm fractures in children using pin leverage technique


  • Alamgir Jhan Department of Orthopaedics, GMC, Haldwani, Uttarakhand, India
  • Wazir Fahad Jan Department of Orthopaedics, SHKM GMC Mewat, Haryana, India
  • Ganesh Singh Dharamshaktu Department of Orthopaedics, GMC, Haldwani, Uttarakhand, India
  • Tajinder Bhalla Department of Orthopaedics, GMC, Patiala, Punjab, India
  • Saika Rasool Department of Gynaecology, GMC, Haldwani, Uttarakhand, India
  • Anoop Nippuleti Department of Orthopaedics, GMC, Haldwani, Uttarakhand, India



Paediatric, Forearm fractures, TENS, Superficial radial nerve


Background: There is a recent trend towards elastic intramedullary nailing in fixation of pediatric forearm bone diaphyseal fractures. But in children we should always attempt closed reduction and immobilsation in a moulded plaster cast. Irreducible, open fractures and those that get redisplaced in moulded plaster cast need operative fixation with intramedullary nailing. Our aim was to know the outcome of tens nailing in such fractures.

Methods: We studied functional and radiological outcome of elastic intramedullary nailing by pin leverage technique in forearm fractures in 34 children. The study was done at a tertiary care centre in Uttrakhand, India from May, 2016 to July, 2018. Inclusion criteria were closed forearm fractures; diaphyseal fractures; age 1 to 19 years. Exclusion criteria were open type 2 and type 3 Gustillo-Anderson fractures; metaphyseal, epiphyseal forearm fractures; age >19 years; pathological fractures.

Results: Closed reduction and percutaneous pin leverage technique for reduction was successful in all but 4 patients where limited open reduction was used for reduction of fracture fragments. All fractures united radiologically between 7 to 13 weeks with mean distribution of 9.2 weeks. For functional outcome we used modified Price and Daruwala’s score. 28 patients showed excellent results and 6 patients showed good results. All our patients had radiological union in mean of 9.2 weeks (7-13 weeks).

Conclusions: Fixation with intramedullary TENS nailing is an effective and affordable way of treating patients in paediatric age group.


Vittus D, Larsen F, Torp-pederson. Angular remodelling of mid-shaft forearm fractures in children. Clin Orthop. 1991;265:261-5.

Richter D, Osterman PA. Elastic intramedullary nailing: a minimally invasive concept in treatment of unstable forearm fractures in children. J Peadiatr Orthop. 1998;18:457-61.

Daruwala JS. A study of radioulnar movements following fractures of forearm in children. Clin Orthop Rel Res. 1979;139:14-20.

Kaj S, Smith C, Oppenheim WL. Both bone midshaft forearm fractures in children. J Pediatr Orthop. 1986;6:306-10.

Verstaken L, Delronge G, Lamoureux J. shaft forearm fractures in children; intramedullary nailing with immediate motion: a preliminary report. J Pediatr Orthop. 1998;8:450-3.

Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma. 2008;65(1):109-15.

Pleogmakers JJW, Verhegen CCPM. Acceptance of angulation in the non-operative treatment of pediatric forearm fractures. J Pediatr Orthop B. 2006;15:418-32.

Vince K, Mike J. Cross-union complicating forearm fractures in children. Part 2, Children. J Bone Joint Surg. 1987;69:654-61.

Amit Y, Salai M, Chechik A, Blankstein A, Horoszowski H. Closed intramedullary nailing for the treatment diaphyseal forearm fractures in adolescence. A preliminary report. J Pediatr Orthop. 1985;5:143-6.

Lascombes P, Haumont T, Journeaure P. Use and abuse of flexible intramedullary nailing in children and adolescence. Pediatr Orthop. 2006;26(6):827-34.

Smith VA, Godman HJ, Strongwater A, Smith B. Treatment of pediatric both bone forearm fractures. A comparison of operative techniques. J Pediatr Orthop. 2005;25(3):309-13.

Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in operative management of Pediatric foerm fractures. J Pediatr Orthop. 2010.30(4):303-19.

Franklinn CC, Robinson J, Noonan K, Flynn JM. Evidence based medicine: management of pediatric forearm fractures. J Pediatr Orthop. 2012;32:513-4.

Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both bone forearm fractures in children. J Pediatr Orthop. 2008;28(9):403.

Yaun PS, Pring ME, Gaynor TP, Mubarak SJ, Newton PO. Compartment syndrome following intramedullary fixation of pediatric forearm fractures. J Peadtr Orthop. 2004;24(4):370-5.

Rodriguez Mechain EC. Peadiatric fractures of the forearm. Clin Orthop. 2005;43(2):65-72.

Schmittenbecher PP. State-of-the-art Treatment of forearm shaft fractures. Injury. 2005;36(Suppl 1):A25-34.

Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63:872-7.

Parajuli NP, shrestha D, Dhoju D, Dhakal GR, Shrestha R, Sharma V. Intramedullary nailing for paediatric diaphyseal forearm fractures. Kathmandu Univ Med J. 2011;35(3):198-202.






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