Pediatric forearm fractures: evaluating implant removal timing and complications with exposed titanium-elastic nail tips

Year 2023, Volume: 6 Issue: 6, 1366 - 1372, 29.10.2023

Fatih Gölgelioğlu , Mustafa Yalın

https://doi.org/10.32322/jhsm.1354354

Abstract

Aims: The current study investigates complication rates, timing of implant removal, and correlations between removal timing and complications/refractures in pediatric forearm fracture patients who had exposed titanium-elastic nail (TEN) tips.
Methods: This retrospective single-center study analyzed pediatric forearm fractures in patients who underwent TEN with exposed tips. Inclusion criteria covered cases between August 2018 and January 2022, focusing on children with both-bone forearm fractures and unsuccessful conservative treatment. Data included demographics, fracture details, reduction type, implant removal timing, complications, and refracture rates.
Results: Between August 2018 and August 2022, the study involved 65 children (54 boys, 11 girls), aged 4 to 15 years. Implant removal occurred at 4 to 11 weeks, on average at 7.17±1.52 weeks. Fracture location was distal 1/3 (9.2%), middle 1/3 (78.5%), proximal 1/3 (12.3%). The predominant causes of fractures were falls (89.2%). Fracture types consisted of open fractures (6.2%) and closed fractures (93.8%). Reduction methods included mini-open reduction (9.2%) and closed reduction (90.8%). Implant removal occurred at or before 6 weeks for 43.1% of cases, while it exceeded 6 weeks for 56.9% of cases. Complications were noted in 21.5% of cases, encompassing delayed union (14.3%), hypertrophic granuloma (7.1%), infection (21.4%), skin irritation (42.9%), and refracture (14.3%). Clinical outcomes were classified as excellent in 83.1% of cases and good in 16.9% of cases. No statistically significant differences were observed in complications (p=0.351) or clinical outcomes (p=0.441) based on implant removal timing.
Conclusion: Contrary to belief, exposing nail tips, not burying them, is safe, cost-effective, and leads to minimal complications with positive clinical outcomes. Implant removal timing did not significantly impact clinical outcomes or complications. TENs used in forearm fractures can be removed before 6 weeks when adequate union is observed.

Keywords

pediatric forearm fractures, titanium elastic nail, exposed tips, implant removal

Ethical Statement

The study was initiated with the approval of the Fırat University Medical Faculty Clinical Researches Ethics Committee (Date: 2023, Decision No: 11-16).

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