Reply to Letter to Editor Regarding the Article: Intramedullary Flexible Nailing for the Diaphyseal Fractures of Forearm Bones in Children

Although fractures of the bones of the forearm are successfully treated conservatively, outcomes remain variable, and, subsequently, some cases may require additional fracture manipulation or formal surgical intervention due to residual angulations.¹ Previous studies have shown that the failure of nonoperative treatment of midshaft fractures in pediatric populations ranges between 39 and 64%.²

Currently, the demands of the modern world lead us to consider the difficulties of nonsurgical treatment while keeping children in plaster casts. Parents work, home care is difficult, time away from school, and even issues of patient comfort are considered. Therefore, fractures, which used to be treated nonoperatively previously, are widely treated surgically with bloodless approach these days.³

In recent times, the flexible intramedullary (IM) nailing has been widely performed for pediatric forearm fractures because of advantages of minimal invasiveness technique and prevention of pin-related complications, it has changed traditional tenets of pediatric forearm fracture care.⁴ Peterlein et al reported good long-term results of pediatric forearm fractures treated with IM nailing.⁵ Martus et al concluded that IM nailing is an effective technique for pediatric forearm fractures with good to excellent outcomes in 91%.⁶

References

• ¹
  Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop 2008;28(04):403-409
• ²
  Bowman EN, Mehlman CT, Lindsell CJ, Tamai J. Nonoperative treatment of both-bone forearm shaft fractures in children: predictors of early radiographic failure. J Pediatr Orthop 2011;31(01):23-32
• ³
  Alvachian Fernandes HJ, Saad EA, Reis FB. Osteosynthesis with intramedullary nails in children. Rev Bras Ortop 2015;44(05):380-385
• ⁴
  Kim BS, Lee YS, Park SY, Nho JH, Lee SG, Kim YH. Flexible Intramedullary Nailing of Forearm Fractures at the Distal Metadiaphyseal Junction in Adolescents. Clin Orthop Surg 2017;9(01): 101-108
• ⁵
  Peterlein CD, Modzel T, Hagen L, Ruchholtz S, Krüger A. Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children. Medicine (Baltimore) 2019;98(11):e14743
• ⁶
  Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA. Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 2013;33(06):598-607

Publication Dates

• Publication in this collection
  03 Feb 2021
• Date of issue
  Nov-Dec 2020