Interlocking nailing of forearm fractures

Abstract

Introduction: With the exception of forearm fractures, intramedullary techniques are preferred for osteosynthesis in the case of long-bone fractures. For the latter, however, the main problem remains insufficient stability against torsional forces resulting in high rates of non-union. This is why plate osteosynthesis by means of a DCP 3.5 or LC-DCP 3.5 is still being described as the standard procedure. Materials and methods: In a prospective study, 32 patients (33 forearms) with fractures of one or both forearm bones were treated by implantation of 40 intramedullary ForeSight^™ nails (ulna: 23; radius: 17). Clinical and radiographic follow-up was performed at 6, 12, 26, and—if needed—52 weeks postoperatively. Time to follow-up was 31.4 months on average (range 24–44 months). Results: The average time to fracture healing for 36 fractures of 29 patients was 4.4 months. A free range of motion was seen in 86%, and only four forearms had a loss of pronation and supination. DASH score averaged at 13.7. There were few complications: non-union 1, delayed union 2, radioulnar synostosis 2, and infections 0. No refracture was seen after 19 implant removals so far. Average time needed per operation was 67 min, average time for fluoroscopy was 4.4 min. Conclusion: This intramedullary nail can do justice to the specific anatomical needs in the case of the forearm. Static interlocking guarantees adequate stability in all fracture types. The surgical technique is demanding. Nonetheless, this system can yield results of comparable quality to those of plate osteosynthesis. So far, no refractures after removal of the implants and no complications connected with the actual implants have been observed.