SAFETY, EFFICACY AND FUNCTIONAL OUTCOME OF FLEXIBLE NAILING (ESIN) IN UNSTABLE FRACTURES OF BOTH BONES OF FOREARM IN CHILDREN

Abstract

Mostly both bone fractures that are indicated to be fixed with plate / plates or may also be surgically treated with flexible nails, through closed / open reduction techniques accordingly. In last decade fracture fixation with flexible nails has gained momentum with proponents arguing that flexible nailing results in decreased surgical dissection with  retention of biological factors at the fracture exudate  site.  Generally, both titanium and stainless-steel flexible nails are being  used for fixation. In most circumstances titanium nail is being used rather than stainless steel because of the flexible elastic properties which are unique to titanium which helps in convenient and improved insertion and rotation while still providing adequate stabilisation for the fracture. The treatment of dia-physeal forearm fractures using open reduction and plate fixation is  generally accepted as the best choice in many studies. However, periosteal stripping, hematoma evacuation may  result in  delayed union, non-union and infection. Re-fracture after plate removal is another concern. To overcome these problems intra-medullary nails with different designs had been used with various outcomes. However previous IM nails  have some short comings such as rotational instability and inter - locking difficulties.