Pediatric forearm fractures with special reference to operatively treated shaft fractures and ulnar styloid process nonnunion

During childhood, the forearm is the most typical area to succumb to fractures. Of these fractures, middle-third fractures and ulnar styloid process fractures are overwhelmingly associated with impaired union. The rate and risk factors of ulnar styloid process nonunion are mostly unknown. The middle-third fractures of forearm tend to displace during cast immobilization, thus, they are often surgically fixed.

Elastic stable intramedullary nailing (ESIN) is the preferred surgical treatment method for forearm shaft fractures; yet, the method has its limitations such as pain and tissue irritation. The titanium implants need to be removed in a secondary operation. Therefore, a new surgical method, biodegradable intramedullary nailing (BIN), has been invented. The implant material is aimed to maintain its strength during bone healing but to absorb in human body in about two years. A randomized trial was performed by using either BIN or ESIN in pediatric patients with forearm shaft fracture.

This thesis aimed to compare the outcomes between these groups after two years of follow-up. In addition, the technical deviations of ESIN, as compared with the current recommendations, were studied in a retrospective cohort. The rate of ulnar styloid nonunion in the patients with a previous distal forearm fracture was analyzed with a long-term follow-up.

The nonunion rate was found to be high (16%), but long-term morbidity was low. Half of the nonunion cases had not been diagnosed for styloid process fractures at the time of injury The two-year clinical outcomes of forearm shaft fractures were good regardless of the BIN or ESIN treatment option. Further implant removal was needed not needed among BIN patients. The finding is promising. However, further studies are needed to assure the right patient selection for this technique.