Failures and complications in intramedullary nailing of children's forearm fractures

Purpose There are published studies of outcomes in the use of ESIN that raise concerns about serious complications: the aim of this study is to report our experiences over 17 years of use of this technique, which shows that complications and failures are insignificant when the method is applied correctly. Method We present a retrospective analysis of 553 children with forearm shaft fractures treated with elastic stable intramedullary nailing over a period of 17 years. The 354 boys (64%) and 199 girls (36%) had an average age of 9.1 years. A total of 61% of the fractures were located in the midshaft, 21% in the distal diaphyseal and 18% in the proximal third. Continuous documentation of treatment, postoperative course and follow-up after an average time of 37 months formed the basis of this study. The analysis included all kinds of failures and complications. Results The following complications and problems were encountered: 5 children with wound infections and disturbed wound healing, 1 case of osteomyelitis, 7 children with ulnar non-unions, 14 children with delayed unions, 6 cases of loss of correction, 15 children with lesions of the superficial radial nerve, one case of malplacement of a nail, 5 children with skin perforations caused by the ends of implants and 27 children with refractures. Conclusion The analysis of the failures and complications shows that a differentiated approach to the data has to be taken. Most complications occur because of incorrect use of the method with neglect of biomechanical principles. The usage of the ESIN method is extended to more problematic regions, such as the distal diaphyseal portion of the forearm, and therefore, an increase in complications is likely. Despite this risk, ESIN should still be the standard treatment for forearm shaft fractures in children, and no change in therapeutical strategy is necessary. However, it is of special importance to follow the right indication and to pay attention to biomechanical principles and to correct technical procedure.