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

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.