Flexible Intramedullary Titanium Elastic Nailing of Fracture Shaft of Radius and Ulna in Children at a Tertiary Care Teaching Hospital

Being so complex and important in relation to function of the upper extremity, injuries of the forearm can result in potentially hazardous consequences. There is no doubt that forearm shaft fractures are potentially harmful and challenging to manage [1]. Displaced fractures of the forearm shaft in children can be reduced and can still be managed with cast, but there is a relatively high incidence of redisplacement, malunion and consequent limitation of function. Union is rarely a problem [2,3]. The most common indications for surgery are failure of closed reduction, open fractures, and fracture instability. In these situations, if left untreated, malunion is more likely to occur, which will disturb the function of the upper extremities [4]. Shoemaker et al. suggested that the ideal mode of fixation of pediatric forearm fractures should maintain alignment, be minimally invasive and inexpensive and carry an acceptable risk profile [5]. As compared to intramedullary fixation, ORIF with plates and screws has got several disadvantages such as large incisions with poor cosmesis, more soft tissue dissection, higher incidence of infections and difficult removal. As far as Intramedullary fixation is concerned there are several implants such as k-wires, Steinmann pin and rush nails but they have their own disadvantages such as Kirschner wires and Rush nails are rigid and difficult to insert through the metaphysis of children’s bones. Because these disadvantages, flexible intramedullary nail (TENS) were devised to overcome this problem which produces a three-point fixation to maintain bony alignment and now become very popular method for managing forearm fractures in children [6].