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The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN (n = 19) or ESIN (n = 16). Forearm rotation at minimally four years’ follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, n = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively.

Introduction: The gold-standard surgical procedure of both-bone forearm shaft fracture repair is elastic stable intramedullary nailing (ESIN). Disadvantages effects of ESIN have suggested to be a consequence of inappropriate surgical techniques, while recommendations are not always followed. The purpose of the study was to analyze the effect of inadequate metal frame construct on impaired fracture healing, refracture and changing alignment. Materials and methods: It is a population-based study including all consecutive patients, aged less than 16 years, who had been treated for forearm shaft fracture by ESIN during the ten-year period 2009–2018. Altogether 71 patients were included. Non-union, delayed union, and re-fracture during the following 12 months were taken as the main outcome, while inferior metal frame construct of ESIN and the surgical technique characteristics were taken the explanatory factors. Radiographic loss of reduction was a secondary outcome and a change >5° in alignment at any postoperative follow-up exam was recognized. Results: Two out of 71 fractures (3%) failed to unite, and ossifying operation was needed. Five cases (7%) showed delayed bone healing, but they ossified in five months without any intervention. These seven patients (10%) had been treated more often with larger nails (> 0.7x MCD) (p = 0.027) and by open reduction (p = 0.02), compared with thinner nails and closed reduction, respectively. Two (3%) patients had a second fracture; however, they happened 2 years after the initial injury. Other surgery or fracture related factors didn’t associate with impaired ossifying. Regarding the secondary outcome, altogether 24 (35%) of the analyzed 67 patients showed >5° change in alignment during the postoperative follow-up but only one patient had clinically significant instability that required re-reduction. The alignment changed more usually in distal-third fractures, compared with middle or proximal third fractures (p = 0.019). C

During childhood, the forearm is the most typical area to succumb to fractures. Of these fractures, shaft fractures and ulnar styloid process (USP) fractures are overwhelmingly associated with impaired union. Elastic stable intramedullary nailing (ESIN) is the preferred surgical treatment method for shaft fractures; yet, the method has its limitations. ESIN is not always performed according to recommendations, resulting in inferior outcomes. Furthermore, there are limitations in traditional methods to measure the function during follow-up, clinically. The rate and risk factors of USP nonunion are mostly unknown. This study aimed to compare the new surgical method, biodegradable intramedullary nailing (BIN), with ESIN. Another aim was to critically analyze the tension metal frame construct of two pre-bended, opposing nails in ESIN. The congruence between the new computer-assisted measuring method and handheld goniometer/dynamometer was aimed to be researched, as well as the rate and long-term morbidity of USP nonunion. Biodegradable nails were produced of poly(L-lactide-co-glycolide) (PLGA) for the purposes of the study. A randomized trial was performed using either BIN or ESIN, and outcomes were evaluated at the two-year mark. The technical deviations of ESIN, as compared with the current recommendations, were studied in a retrospective cohort. E-link was analyzed through comparative study. The rate of USP nonunion in the patients with a previous distal forearm fracture was analyzed with a mean of 11 years of follow-up. The two-year clinical outcomes of forearm shaft fractures were good regardless of the BIN or ESIN treatment option. Two unexpected refractures occurred in adolescents treated with BIN. The recommended tension metal frame in ESIN was not achieved in 79% of the cases. Thicker nails and open reduction were associated with impaired bone healing. The computer-assisted measuring method was feasible in practice but not congruent with the traditiona, Tiivistelmä Lapsilla luun murtumat ovat kaikkein yleisimpiä kyynärvarren alueella. Kyynärvarren murtumista putkiluun keskiosan kahden luun murtumat sekä kyynärluun distaalisen puikkolisäkkeen murtumat ovat alttiita komplikaatioille. Tutkimuksen tavoitteena oli selvittää kyynärvarren keskiosan murtumien hoitoa uudella ydinnaulaustekniikalla käyttäen sulavia ydinnauloja (biodegradable intramedullary nailing, BIN). Lisäksi tavoitteena oli tutkia joustavan ydinnaulauksen (elastic stable intramedullary nailing, ESIN) teknistä onnistumista. Tavoitteena oli tutkia yläraajamurtuman kliinisten myöhäistuloksien mittaamista tietokoneavusteisella menetelmällä sekä selvittää kyynärluun puikkolisäkkeen (ulnar styloid process, USP) luutumattomuutta. Sulavien ydinnaulojen kahden vuoden tuloksia verrattiin titaanisilla joustavilla ydinnauloilla hoidettuihin potilaisiin satunnaistetussa, etenevässä hoitokokeessa. ESIN:n muodostaman jännitteisen, metallisen kaksoiskaaren saavuttamista analysoitiin taannehtivasti sairaalan potilasaineistossa. Tietokoneavusteista mittausmenetelmää tutkittiin vertailevassa työssä ja USP:n luutumattomuudesta seuraavia pitkäaikaistuloksia arvioitiin pitkäaikaisessa (keskimäärin 11 v.) seurantatutkimuksessa. Sulavilla ydinnauloilla hoidettujen potilaiden 2-vuoden liikeala ja puristusvoimat olivat yhtä hyvät kuin titaanisilla nauloilla hoidetuilla. Titaaniset esitaivutetut ydinnaulat oli useimmilla (79 %) potilailla aseteltu vastoin suositusta niin, että ydinnaulat eivät muodostaneet jännitteistä kaksoiskaarikehikkoa. Tietokoneavusteisen mittauksen etuna oli vaivattomuus, mutta mittaustulokset eivät olleet yhtenevät perinteisen kulma- ja puristusvoimamittauksen kanssa. Puikkolisäkkeen luutumattomuus oli yleistä (16 %) rannemurtuman jälkeen, mutta oireita oli harvalla. Puolet puikkolisäkkeen murtumista oli jäänyt alun perin havaitsematta.

Background: Proximal humerus fractures comprise approximately 2% of all pediatric fractures. In general, upper extremity fractures have increased in children. However, recent trends of proximal humerus fractures are not analyzed yet. The aim was to study the incidence and treatment trends of proximal humerus fractures in children. Methods: All 300 children, aged < 16 years, who suffered from a proximal humerus fracture in the catchment area of Oulu University Hospital, Finland, between 2005 and 2015, were included. Radiographs were reviewed, and patients, injuries, treatments, and outcomes were comprehensively studied. Annual incidence was based on the child population at risk, which changed between 84.500 and 88.100 in the study time. Results: The annual incidence of childhood proximal humerus fractures was mean 31.4/100,000 and no variation trend was found. The majority (92%) was treated nonoperatively, however, there was an increase of operative fixation from 0 to 16% during the study time (Difference 16, 95% CI 0.3 to 34.9%, P = 0.045). Bayonet displacement increased the risk of surgical fixation up to 16-fold (95% CI 4.8–51.4, P < 0.001) in a multivariate analysis when adjusted with other potential risk factors. Higher age was also associated with operative treatment (P = 0.002). The most usual recreational activities were horse riding, downhill skiing, snowboarding, and trampolining. Conclusion: Contrary to most upper extremity fractures in children, proximal humerus fractures did not increase during the long study period. However, their operative treatment increased compared to nonoperative treatment, but the evidence supporting that trend remains unclear.