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Delayed Healing Not Common Following Intramedullary Nailing for Forearm Shaft Fractures in Children

When a child breaks his or her arm, it is most often the radial humeral condyle that is affected. Most often, healing is rapid and uneventful. Delays in healing, when they occur, are most often due to developmental failure of the bone, open or comminuted fractures, or a treatment failure.

Currently, the treatment of choice for displaced fractures in the forearm is to use elastic stable intramedullary [within the bone marrow] nailing (ESIN). This treatment provides rapid healing with minimal complications in most patients. The authors of this study evaluated how often this treatment was not successful or caused delayed healing.

Researchers studied records of 532 children who presented to any of five pediatric trauma units with a forearm shaft fracture treated with ESIN. Among those treated, they found 10 children (five boys, five girls), or 1.9 percent of the group, had delayed healing of the fracture. Among the fractures, one was a repeat fracture, three were type 1 open fractures. Six patients were treated with open procedure. One patient experienced an infection after surgery.

The researchers could not determine any visible reason for the delay in healing. Five children had their nails extracted, two were casted, two had surgical revisions and one received no further treatments. Full healing in all patients happened within 10 to 13 months following the initial injury.

The authors conclude treatment with ESIN for unstable and displaced forearm shaft fractures results in adequate healing and function in most patients. Delayed healing does occur rarely, however, healing completes by the 13th month.

References: Peter P. Schimettenbecher, MD, et al. Delayed Healing of Forearm Shaft Fractures in Children After Intramedullary Nailing. In Journal of Pediatric Orthopaedics. April/May 2008. Vol. No. 3. Pp. 303-306.

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