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Pediatric Forearm Fractures: Surgical Intervention Techniques & Complications

Explore surgical intervention techniques and potential complications in managing pediatric forearm fractures. Learn about indications, fixation methods, and outcomes to make informed decisions.

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Pediatric Forearm Fractures: Surgical Intervention Techniques & Complications

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  1. Forearm Fractures in Children Intramedullary Pin Fixation

  2. Norman Ramirez MD

  3. Indications for SurgicalIntervenion • Grade I Open Fractures • Associated Soft Tissue Injuries • Inability To MaintainA Closed Reduction • Floating elbow • Refractures(relative) Pediatricforearm fractures :decisionmaking ,surgicaltechniques and complications. J FlynnInstrCourse 2002 Eleven yearsexperience in theoperativemanagement of pediatricsforearm fractures J Flynn et al JPO 2010

  4. Always Have A Direct Line Of Sight !!

  5. Pins Placed Proximal to Distal

  6. Pins Placed Distal to Proximal

  7. Ulnar Fixation

  8. Ulnar Incision Beware 2nd Route Dorsal Branch Ulnar Nerve Usual Route

  9. Ulnar Fixation Exposing Distal Ulna

  10. Drilling Ulnar Metaphysis

  11. Preparing the Pin End (Two Curves) 2.Proximal Gentle Curve 1.Terminal 30 degree

  12. Two Curves in the Distal portion • Gentle Metaphyseal • 30 Degree Short

  13. Passing the Pin Proximally Two Methods : 1. Hand Drilling Pin by Rotation

  14. 2. Hand Tap With Mallet

  15. Exposed Nails There were no significant differences seen in number of infections, refractures, or overall complications Exposed versus buried intramedullary implants for pediatric forearm fractures: a comparison of complications. Kelly BA JPO 2014

  16. 180 degree Bend To Produce Low-Profile Influence of the bending of the tip of elastic stable intramedullary nails on removal and associated complications in pediatric both bone forearm fractures: a pilot study. Gibon E Int J Surg 2015

  17. Final Pin Placement Next To Metaphysis

  18. Radius Fixation

  19. Beware!! Superficial Radial Nerve Radial Incision

  20. DeepStructures Extensor Pollicus Brevis Brachioradialis Extensor pollicis longus rupture after fixation of radius and ulna fracture with titanium elastic Nail (TEN) in a child : a case report Kravel et al J Trauma 2007 Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures. Lee AK JPO 2016

  21. Drilling Metaphysis 2.5 mm drill

  22. Approaching the Fracture Site Insertion Radial Pin Gentle Curve Allows Bouncing Off Cortex

  23. Then Rotating Pin In Proximal Fragment To Reduce Fracture Rotating 30 degree bend in prox . fragment to engage the canal in the proximal fragment

  24. Then Passing Proximally Entering Proximal Fragment

  25. Terminal Insertion

  26. Final Position

  27. X- Rays Plain Films to Check Final Position

  28. Two Months Follow Up Good Strong Callous Pins Stimulate Endosteal Callous Clinicalresults of IM followingclosedor mini open reduction in pediatricsunstable diaphysealforearm fractures Yalcinkaya et al Acta OrthopTraumatologicaTurc 2010

  29. Complications…. 14 % 1. Compartment Syndrome ( > three attempts) 2. Hardware migration 3. No union 4. Infection 5. Neurologic problems 6. Tendon Ruptures 7. Delayed union ( > 10 years) Compartment syndrome following intrarmedullary fixation of pediatric forearm fractures Yuan et al JPO 2004 Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. Martus J. JPO 2013 Acute compartment syndrome after intramedullary nailing of isolated radius and ulna fractures in children.Blackman AJ J Pediatr Orthop. 2014

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