The Outcomes of Intra-Medullary Square Nail for Adult Both Bone Forearm Shaft Fractures
,
Abstract
Background: Forearm shaft fractures are common in developing countries. Anatomical reduction of these fractures using plates and screws is considered an accepted treatment mode. Like other shaft fractures, this can be treated with intramedullary nails like square nails, Rush nails, and interlocking nails. This study evaluates radiological and functional treatment results using square nailing.
Methods: A prospective study was conducted on 100 adult patients with diaphyseal forearm fractures over 3 years. Out of 100 patients, 68 were men, and 32 were women. Patients were followed up at 2 weeks, 6 weeks, 8 weeks, and then every 3 months till 1 to
1.5 years. We have used criteria described by Anderson et al. and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score for functional evaluation of the patients.
Results: Out of 100 patients, the union was achieved in 88 patients, while the rest 12 patients required re-surgery. 4 patients had delayed union, 4 patients developed an infection at the ulnar entry site, and 3 patients developed bursitis of olecranon bursa.
Conclusion: Intramedullary nailing of both bone forearm shaft fractures using square nails can give satisfactory results in most cases, comparable with treatment by plates and screws, and provides an alternative, cost-effective treatment of both bone forearm shafts fractures with good cosmesis owing to small incisions.
1. Hong DY, Berube ER, Strauch RJ. Non-operative management of adult both bone forearm fractures - a case report and literature review. J Orthop Case Rep. 2020;10(7):53-6. doi: 10.13107/jocr.2020.v10.i07.1916. [PubMed: 33585317]. [PubMed Central: PMC7857656].
2. Jupiter JB, Kellam JF. Diaphyseal fractures of the forearm. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: Fractures, dislocations, and ligamentous injuries. Philadelphia, PA: Saunders; 2003. p. 1363-403.
3. Knight RA, Purvis GD. Fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1949;31A(4):755-64. [PubMed: 18148996].
4. Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am. 1988;70(9):1372-6. [PubMed: 3182889].
5. Mih AD, Cooney WP, Idler RS, Lewallen DG. Long-term follow- up of forearm bone diaphyseal plating. Clin Orthop Relat Res. 1994;(299):256-8. [PubMed: 8119028].
6. Beaupre GS, Csongradi JJ. Refracture risk after plate removal in the forearm. J Orthop Trauma. 1996;10(2):87-92. doi: 10.1097/00005131-199602000-00003. [PubMed: 8932666].
7. Sage FP. Medullary fixation of fractures of the forearm. A study of the medullary canal of the radius and a report of fifty fractures of the radius treated with a prebent triangular nail. J Bone Joint Surg Am. 1959;41-A:1489-516. [PubMed: 13854617].
rd
of 13 (range: 3-25) in patients treated with rods.
8. Anderson LD, Sisk D, Tooms RE, Park WI 3
. Compression-plate
Visna et al. reported the results of a prospective study evaluating 80 patients with 115 forearm fractures treated with either plate or nail fixation (19). There was one re- fracture following plate removal. There were 2 cases of incomplete synostosis and 2 cases of partial migration of the interlocking screw in the nail group. No significant differences in functional outcomes were detected.
Conclusion
Intramedullary nailing of both bone forearm shaft fracture using square nails can give satisfactory results in most cases, and its results are comparable with treatment by plates and screws. Due to the small incisions, it provides an alternative, cost-effective treatment of both bone forearm shaft fractures with good cosmesis.
Conflict of Interest
The authors declare no conflict of interest in this study.
Acknowledgements
This study was performed at Pandit Deendayal Upadhyay Medical College and Government Hospital, Rajkot, Gujarat, India.
The research was not funded as it was conducted in a government institute where treatment is provided free of cost.
References
1. Hong DY, Berube ER, Strauch RJ. Non-operative management of adult both bone forearm fractures - a case report and literature review. J Orthop Case Rep. 2020;10(7):53-6. doi: 10.13107/jocr.2020.v10.i07.1916. [PubMed: 33585317]. [PubMed Central: PMC7857656].
2. Jupiter JB, Kellam JF. Diaphyseal fractures of the forearm. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: Fractures, dislocations, and ligamentous injuries. Philadelphia, PA: Saunders; 2003. p. 1363-403.
3. Knight RA, Purvis GD. Fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1949;31A(4):755-64. [PubMed: 18148996].
4. Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint
fixation in acute diaphyseal fractures of the radius and ulna. J
Bone Joint Surg Am. 1975;57(3):287-97. [PubMed: 1091653].
9. Al-Sadek TA, Niklev D, Al-Sadek A. Diaphyseal fractures of the forearm in adults, plating or intramedullary nailing is a better option for the treatment? Open Access Maced J Med Sci. 2016;4(4):670-3. doi: 10.3889/oamjms.2016.138. [PubMed: 28028411]. [PubMed Central: PMC5175519].
10. Moerman J, Lenaert A, De Coninck D, Haeck L, Verbeke S, Uyttendaele D, et al. Intramedullary fixation of forearm fractures in adults. Acta Orthop Belg. 1996;62(1):34-40. [PubMed: 8669253].
11. Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res. 1983;(175):25-9. [PubMed: 6839596].
12. Dave MB, Parmar KD, Sachde BA. The radial bow following square nailing in radius and ulna shaft fractures in adults and its relation to disability and function. Malays Orthop J. 2016;10(2):11-5. doi: 10.5704/MOJ.1607.003. [PubMed: 28435555]. [PubMed Central: PMC5333648].
13. Street DM. Intramedullary forearm nailing. Clin Orthop Relat Res. 1986;(212):219-30. [PubMed: 3769288].
14. Lil NA, Makkar DS, Aleem AA. Results of closed intramedullary nailing using Talwarkar square nail in adult forearm fractures. Malays Orthop J. 2012;6(3):7-12. doi: 10.5704/MOJ.1207.013. [PubMed: 25279048]. [PubMed Central: PMC4093594].
15. Hong G, Cong-Feng L, Hui-Peng S, Cun-Yi F, Bing-Fang Z. Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails. Clin Orthop Relat Res. 2006;450:186-92. doi: 10.1097/01.blo.0000214444.87645.75. [PubMed: 16523119].
16. Weckbach A, Blattert TR, Weisser C. Interlocking nailing of forearm fractures. Arch Orthop Trauma Surg. 2006;126(5): 309-15. doi: 10.1007/s00402-006-0122-9. [PubMed: 16525808].
17. Lee YH, Lee SK, Chung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am. 2008;90(9):1891-8. doi: 10.2106/JBJS.G.01636. [PubMed: 18762649].
18. Ozkaya U, Kilic A, Ozdogan U, Beng K, Kabukcuoglu Y. Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures. Acta Orthop Traumatol Turc. 2009;43(1):14-20. [In Turkish]. doi: 10.3944/AOTT.2009.014. [PubMed: 19293611].
19. Visna P, Vlcek M, Valcha M, Beitl E, Jaganjac E, Smidl Z. Management of diaphyseal forearm fractures using LCP angle- stable fixation devices and intramedullary nailing. Rozhl Chir. 2009;88(12):708-15. [In Czech]. [PubMed: 20662434].
2. Jupiter JB, Kellam JF. Diaphyseal fractures of the forearm. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: Fractures, dislocations, and ligamentous injuries. Philadelphia, PA: Saunders; 2003. p. 1363-403.
3. Knight RA, Purvis GD. Fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1949;31A(4):755-64. [PubMed: 18148996].
4. Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am. 1988;70(9):1372-6. [PubMed: 3182889].
5. Mih AD, Cooney WP, Idler RS, Lewallen DG. Long-term follow- up of forearm bone diaphyseal plating. Clin Orthop Relat Res. 1994;(299):256-8. [PubMed: 8119028].
6. Beaupre GS, Csongradi JJ. Refracture risk after plate removal in the forearm. J Orthop Trauma. 1996;10(2):87-92. doi: 10.1097/00005131-199602000-00003. [PubMed: 8932666].
7. Sage FP. Medullary fixation of fractures of the forearm. A study of the medullary canal of the radius and a report of fifty fractures of the radius treated with a prebent triangular nail. J Bone Joint Surg Am. 1959;41-A:1489-516. [PubMed: 13854617].
rd
of 13 (range: 3-25) in patients treated with rods.
8. Anderson LD, Sisk D, Tooms RE, Park WI 3
. Compression-plate
Visna et al. reported the results of a prospective study evaluating 80 patients with 115 forearm fractures treated with either plate or nail fixation (19). There was one re- fracture following plate removal. There were 2 cases of incomplete synostosis and 2 cases of partial migration of the interlocking screw in the nail group. No significant differences in functional outcomes were detected.
Conclusion
Intramedullary nailing of both bone forearm shaft fracture using square nails can give satisfactory results in most cases, and its results are comparable with treatment by plates and screws. Due to the small incisions, it provides an alternative, cost-effective treatment of both bone forearm shaft fractures with good cosmesis.
Conflict of Interest
The authors declare no conflict of interest in this study.
Acknowledgements
This study was performed at Pandit Deendayal Upadhyay Medical College and Government Hospital, Rajkot, Gujarat, India.
The research was not funded as it was conducted in a government institute where treatment is provided free of cost.
References
1. Hong DY, Berube ER, Strauch RJ. Non-operative management of adult both bone forearm fractures - a case report and literature review. J Orthop Case Rep. 2020;10(7):53-6. doi: 10.13107/jocr.2020.v10.i07.1916. [PubMed: 33585317]. [PubMed Central: PMC7857656].
2. Jupiter JB, Kellam JF. Diaphyseal fractures of the forearm. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: Fractures, dislocations, and ligamentous injuries. Philadelphia, PA: Saunders; 2003. p. 1363-403.
3. Knight RA, Purvis GD. Fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1949;31A(4):755-64. [PubMed: 18148996].
4. Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint
fixation in acute diaphyseal fractures of the radius and ulna. J
Bone Joint Surg Am. 1975;57(3):287-97. [PubMed: 1091653].
9. Al-Sadek TA, Niklev D, Al-Sadek A. Diaphyseal fractures of the forearm in adults, plating or intramedullary nailing is a better option for the treatment? Open Access Maced J Med Sci. 2016;4(4):670-3. doi: 10.3889/oamjms.2016.138. [PubMed: 28028411]. [PubMed Central: PMC5175519].
10. Moerman J, Lenaert A, De Coninck D, Haeck L, Verbeke S, Uyttendaele D, et al. Intramedullary fixation of forearm fractures in adults. Acta Orthop Belg. 1996;62(1):34-40. [PubMed: 8669253].
11. Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res. 1983;(175):25-9. [PubMed: 6839596].
12. Dave MB, Parmar KD, Sachde BA. The radial bow following square nailing in radius and ulna shaft fractures in adults and its relation to disability and function. Malays Orthop J. 2016;10(2):11-5. doi: 10.5704/MOJ.1607.003. [PubMed: 28435555]. [PubMed Central: PMC5333648].
13. Street DM. Intramedullary forearm nailing. Clin Orthop Relat Res. 1986;(212):219-30. [PubMed: 3769288].
14. Lil NA, Makkar DS, Aleem AA. Results of closed intramedullary nailing using Talwarkar square nail in adult forearm fractures. Malays Orthop J. 2012;6(3):7-12. doi: 10.5704/MOJ.1207.013. [PubMed: 25279048]. [PubMed Central: PMC4093594].
15. Hong G, Cong-Feng L, Hui-Peng S, Cun-Yi F, Bing-Fang Z. Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails. Clin Orthop Relat Res. 2006;450:186-92. doi: 10.1097/01.blo.0000214444.87645.75. [PubMed: 16523119].
16. Weckbach A, Blattert TR, Weisser C. Interlocking nailing of forearm fractures. Arch Orthop Trauma Surg. 2006;126(5): 309-15. doi: 10.1007/s00402-006-0122-9. [PubMed: 16525808].
17. Lee YH, Lee SK, Chung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am. 2008;90(9):1891-8. doi: 10.2106/JBJS.G.01636. [PubMed: 18762649].
18. Ozkaya U, Kilic A, Ozdogan U, Beng K, Kabukcuoglu Y. Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures. Acta Orthop Traumatol Turc. 2009;43(1):14-20. [In Turkish]. doi: 10.3944/AOTT.2009.014. [PubMed: 19293611].
19. Visna P, Vlcek M, Valcha M, Beitl E, Jaganjac E, Smidl Z. Management of diaphyseal forearm fractures using LCP angle- stable fixation devices and intramedullary nailing. Rozhl Chir. 2009;88(12):708-15. [In Czech]. [PubMed: 20662434].
| Files | ||
| Issue | Vol 9 No 3 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i3.13021 | |
| Keywords | ||
| Forearm Injuries Intramedullary Nailing Radius Fractures Ulna Fractures | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Savajiyani D, Chauhan N, Ramavat S. The Outcomes of Intra-Medullary Square Nail for Adult Both Bone Forearm Shaft Fractures. J Orthop Spine Trauma. 2023;9(3):125-8.
