Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing

  • Bingqiang Han
  • Zhigang Wang
  • Yuchan Li
  • Yunlan Xu
  • Haiqing CaiEmail author
Original Paper



This study aims to investigate risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing (ESIN).


Clinical data of 267 patients who had been treated for forearm fractures by ESIN in our hospital from January 2010 to December 2014 were retrospectively reviewed. Risk factors for forearm refractures were determined using logistic regression analysis.


Forearm refractures occurred in 11 children. Univariate analysis revealed that age, body weight, number of fractures, open fracture, nail diameter, and immobilization time were not associated with refractures. However, gender (male, P = 0.042) and fracture location (lower third, P = 0.007) were significantly associated with refractures. Multivariate analysis revealed that fracture location was an independent risk factor for forearm refractures (P = 0.031).


Forearm refracture is uncommon in children treated with ESIN. Fracture location is an independent risk factor for forearm refractures in these patients.


Forearm Refracture Elastic stable intramedullary nailing Children 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kosuge D, Barry M (2015) Changing trends in the management of children’s fractures. Bone Joint J 97(4):442–448CrossRefGoogle Scholar
  2. 2.
    Hussain S, Dar T, Beigh AQ, Dhar S, Ahad H, Hussain I, Ahmad S (2015) Pattern and epidemiology of pediatric musculoskeletal injuries in Kashmir valley, a retrospective single-center study of 1467 patients. J Pediatr Orthop B 24(3):230–237CrossRefGoogle Scholar
  3. 3.
    Sinikumpu JJ, Serlo W (2015) The shaft fractures of the radius and ulna in children: current concepts. J Pediatr Orthop B 24(3):200–206CrossRefGoogle Scholar
  4. 4.
    Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG (1999) Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop 19(3):329–337PubMedGoogle Scholar
  5. 5.
    Luhmann SJ, Gordon JE, Schoenecker PL (1998) Schoenecker, Intramedullary fixation of unstable both-bone forearm fractures in children. J Pediatr Orthop 18(4):451–456PubMedGoogle Scholar
  6. 6.
    Kuremsky MA, Frick SL (2007) Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr 19(1):51–57CrossRefGoogle Scholar
  7. 7.
    Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26(6):827–834CrossRefGoogle Scholar
  8. 8.
    Bould M, Bannister GC (1999) Refractures of the radius and ulna in children. Injury 30(9):583–586CrossRefGoogle Scholar
  9. 9.
    Schwarz N, Pienaar S, Schwarz AF, Jelen M, Styhler W, Mayr J (1996) Refracture of the forearm in children. J Bone Joint Surg Br 78(5):740–744CrossRefGoogle Scholar
  10. 10.
    van Egmond PW, van der Sluijs HA, van Royen BJ, Saouti R (2013) Refractures of the paediatric forearm with the intramedullary nail in situ. BMJ Case Rep. Google Scholar
  11. 11.
    Park HW, Yang IH, Joo SY, Park KB, Kim HW (2007) Refractures of the upper extremity in children. Yonsei Med J 48(2):255–260CrossRefGoogle Scholar
  12. 12.
    Salem KH, Lindemann I, Keppler P (2006) Flexible intramedullary nailing in pediatric lower limb fractures. J Pediatr Orthop 26(4):505–509CrossRefGoogle Scholar
  13. 13.
    Karaman I, Halici M, Kafadar IH, Guney A, Oner M, Gurbuz K, Karaman ZF (2014) Mid-term results of the elastic intramedullary nailing in paediatric long bone shaft fractures: a prospective study of 102 cases. J Pediatr Orthop B 23(3):212–220CrossRefGoogle Scholar
  14. 14.
    Fernandez FF, Eberhardt O, Langendörfer M, Wirth T (2009) Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B 18(6):289–295CrossRefGoogle Scholar
  15. 15.
    Schmittenbecher PP, Fitze G, Gödeke J, Kraus R, Schneidmüller D (2008) Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 28(3):303–306CrossRefGoogle Scholar
  16. 16.
    Baitner AC, Perry A, Lalonde FD, Bastrom TP, Pawelek J, Newton PO (2007) The healing forearm fracture: a matched comparison of forearm refractures. J Pediatr Orthop 27(7):743–747CrossRefGoogle Scholar
  17. 17.
    Tisosky AJ, Werger MM, McPartland TG, Bowe JA (2015) The factors influencing the refracture of pediatric forearms. J Pediatr Orthop 35(7):677–681CrossRefGoogle Scholar
  18. 18.
    Fuller DJ, McCullough CJ (1990) Malunited forearm fractures in children. J Pediatr Orthop 10(6):705–712CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Bingqiang Han
    • 1
  • Zhigang Wang
    • 1
  • Yuchan Li
    • 1
  • Yunlan Xu
    • 1
  • Haiqing Cai
    • 1
    Email author
  1. 1.Department of Pediatric Orthopedics, Shanghai Children’s Medical CenterShanghai Jiaotong University School of MedicineShanghaiPeople’s Republic of China

Personalised recommendations