Delayed healing of forearm shaft fractures in children after intramedullary nailing.
BACKGROUND
In displaced and unstable forearm shaft fractures, elastic stable intramedullary nailing represents the current treatment of choice. Delayed healing has been observed in single cases, but the incidence of healing disturbances remains unclear.


METHODS
Retrospective analysis of all patients with forearm shaft fractures and open epiphyseal plates, treated with elastic stable intramedullary nailing between 2000 and 2004 in 5 pediatric trauma units, was conducted. Evaluation of cases with insufficient consolidation 90 days after osteosynthesis was performed.


RESULTS
Ten (1.9%) of 532 cases showed delayed healing. Mean age (12.3 years), part of open fractures (30%), and part of open reductions (60%) were clearly higher than in a nonselected collective; the ulna was concerned in 70%. One refracture, 1 local soft tissue infection, and 1 small sequestration were found. In 5 children, nails were extracted with (2x) or without (3x) local surgical intervention. In the other 5 children, the nails were left in place. All fractures healed within 13 months posttrauma without relevant functional restrictions.


CONCLUSIONS
Delayed healing is possible especially in open fractures or open reduced fractures of the ulna in older children, but healing takes place up to 13 months. Therefore, no change of treatment principles is necessary. Protection of ulna periost has to remain in the center of surgical focus.


METHODS
Retrospective comparative study, Level III.
Schmittenbecher
Peter P
PP
Department of Pediatric Surgery, St Hedwigs Hospital, Clinical Center Barmherzige Brüder, Regensburg, Germany. peter.schmittenbecher@klinikum-karlsruhe.de
Fitze
Guido
G
Gödeke
Jan
J
Kraus
Ralf
R
Schneidmüller
Dorien
D
D000293:Adolescent; D002648:Child; D003646:Debridement; D005260:Female; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014945:Wound Healing