Role of Rush Nail in Fracture Forearm Bones with or Without Bone Graft

Background: Rush nail is a very handy, low cost easily available implant. In the present study, we have tried to find out its applicability in fracture of both bones with ORIF with or without Bone graft. The objectives were to evaluate the results of intramedullary fixation of fractures of both bone forearm in terms of fracture union, range of movement complications and functional outcome. Materials and Methods: This study was conducted on 60 adult subjects. Skeletally mature subjects with Gustilo Type 1 open and closed subjects were included in the study while the subjects having Gustilo Type 2 & 3 open, with neurovascular deficit were excluded from the study. Stainless steel rush nails were used for all the patients for both radius and ulnar repair through conventional surgical approach to radius and ulna. In fractures older than ten days autogenous cancellous graft was used. Follow-up was done at 6, 12 weeks & till fracture union postoperatively. Results: Mean Age of the study was 36.2 years & mean time of union was 14.8 weeks. No intra-operative complication occurred, there was no case with nonunion of both bones, Hardware failure was noted in 4 cases, 2 cases developed ulnar non union, in one case due to physical activity ulnar nail bent and only one nail had protrusion of ulnar nail. Only 3 patients developed superficial stitch abscess which improved with antibiotics and none had deep infection. Using Andreson criteria results were evaluated and 48 patients (80%) had satisfactory to excellent results. Conclusion : Use of rush nails continues to have predictable and good results, complication results are lower when compared to plate osteosynthesis although application of above elbow cast after nailing is a downside of this procedure. Open reduction and fixation with rush nail still has a prospect in repair of forearm fractures considering its low complication rates, cost and acceptable results in a developing country like India where financial matters and non availability of C-arm image intensifier are to be considered.