[Impact of buried versus exposed flexible intramedullary nails osteosynthesis on pediatric forearm fractures].

In elastic stable intramedullary nailing (ESIN), there are different opinions among surgeons on whether to leave the nail buried in the same arm or to leave it exposed.

Objective: To determine the risk of re-fracture in patients with a nail buried directly into the amr or left exposed as a treatment for forearm fractures, and to investigate postoperative complications.

Patients and method: The study included 113 pediatric patients with a forearm fracture of both diaphyses. Two groups were formed according to whether the nail was buried (Group B, n: 53) in the same arm or left exposed (Group E, n: 60). Data on the number of open reductions, the time to nail removal, the anesthesia type used for its removal, the number of re-fractures, skin infection, and nail entry site irritation were analyzed.

Results: The mean union times between the groups were not significantly different (P = 0.371). The mean time of nail removal in group B (16.02 ± 1.29 weeks) was significantly longer than that of group E (6.65 ± 0.95 weeks) (P < 0.001). Open reduction rates were similar between groups (P = 0.401). The general anesthesia rate for nail removal in group B (77.4%) was significantly higher than group E (11.7%) (P < 0.001). The re-fracture rate was higher in patients who underwent open reduction in both groups (P < 0.001).

Conclusion: The results of this study demonstrated that, despite the increased infection rate, leaving the nail exposed did not increase the re-fracture rate, which was associated with open reduction.