J Korean Fract Soc.  2009 Jan;22(1):30-38. 10.12671/jkfs.2009.22.1.30.

Interlocking Intramedullary Nailing of Forearm Shaft Fractures in Adults

• Lee S
• Lee HS
• Sung YB
• Yum JK

• KMID: 2183885
• DOI: http://doi.org/10.12671/jkfs.2009.22.1.30

Abstract

PURPOSE
To evaluate the usefulness of interlocking intramedullary nailing for operative treatment of forearm shaft fractures in adults.
MATERIALS AND METHODS
Thirteen forearm shaft fractures in 12 patients were fixated with 13 Acumed forearm intramedullary rods (ulna: 8, radius: 5). The average age was 36.7 years and mean follow-up period was 15.2 months. The union time was measured when there was no tenderness over the fracture site and the bridging callus was evident in at least two sides of the cortex. The range of motion of the joint and the rotation of the forearm was measured and the functional results were evaluated with Grace and Eversmann's rating system.
RESULTS
Radiologic union was observed at 11.8 weeks postoperatively in 11 cases out of 13. No limitation of motion was observed. Nine had excellent or good functional results. In one Galeazzi fracture, radial shaft became displaced after nailing and should be re-stabilized with plate. Proximal interlocking screws were improperly inserted in one ulnar nail. Implants were removed in 7 cases. Removal guide screw was broken while removing the intramedullary nail in one case of ulnar shaft fracture.
CONCLUSION
Interlocking intramedullay nailing might be a treatment option for the middle 1/3 shaft fractures of the adult forearm bone with favorable results.

Keyword

Forearm; Shaft fracture; Interlocking; Intramedullary nail

MeSH Terms

Adult
Bony Callus
Follow-Up Studies
Forearm
Fracture Fixation, Intramedullary
Humans
Joints
Nails
Range of Motion, Articular

Figure

• 

  Fig. 1 (A) Photograph shows the left radial rod (anterior view), right radial rod (anterior view), right radial rod (lateral view), ulnar rod (anterior view), and ulnar rod (lateral view) from left to right. (B) The radial rod is assembled with the targeting guide. The drill guide for an interlocking screw is inserted through the cannula. (C) The ulnar rod is inserted with the targeting guide. (D) The probe is tapped on the skin to indicate the incision site for the screw.

• 

  Fig. 2 (A) Preoperative radiographs of the forearm of 17-year-old male patient showed ulnar oblique and radial transverse shaft fracture after slip-down from the stairs. (B) Ulna was fixated with plate and screws and radius was reduced closely and stabilized with the intramedullary nail. (C) Fracture gap was not observed on the radiograph and the patient had no tenderness on the fracture site at 8 weeks postoperatively. (D) At postoperative one year, metal was removed. No complication had been observed till one year after removal with 'excellent' functional result in the Grace and Eversmann rating system.

• 

  Fig. 3 (A) Preoperative X-ray showed ulnar shaft comminuted fracture. (B) Immediate postoperative X-ray showed that ulna was fixated with intramedullary nail. (C) Radiographs showed increased gap in the fracture site at four weeks postoperatively and patient reported pain during the motion of wrist and elbow. Then, they were immobilized with long arm splint until the pain was subsided for about two weeks. (D) Radiographs at postoperative one year showed solid union without additional bone grafting.

• 

  Fig. 4 (A) Preoperative radiographs of the forearm of 28-year-old female patient showed ulnar transverse shaft fracture. (B) Immediate postoperative X-ray showed that ulna was fixated with intramedullary nail. (C) Intraoperative C-arm film showed removal of IM nail. (D) At postoperative 17 months, metal was removed.

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