# Closed Reduction Nailing or Open Reduction Plating in Unstable Paediatric Forearm Fractures: A Case of Paediatric Forearm Fracture Implant Failure

## TL;DR

The paper discusses a case where a titanium nail system failed in a child's forearm fracture, suggesting that plating may be more effective than nailing for such injuries.

## Contribution

The paper presents a clinical case highlighting the limitations of titanium elastic nailing in pediatric forearm fractures and advocates for primary plating as a better alternative.

## Key findings

- TENS nailing can lead to implant failure and refractures in pediatric diaphyseal forearm fractures.
- Open reduction and plating allow better correction of malrotation and restoration of radial bow.
- Primary plating is suggested as a superior option compared to TENS nailing in juvenile patients.

## Abstract

A significant amount of all paediatric fractures are forearm fractures involving the radius, ulnar shaft, or both. As surgical stabilisation lowers the likelihood of re-displacement, surgical intervention is currently recommended over conservative treatment of such fractures involving significant displacement and angulation. Open reduction and plating can better anatomically repair the majority of fractures. Bracing is necessary for the first six to eight weeks after nailing since nailing does not give a rigid fixation. External bracing is generally not necessary for plating. In our facility, paediatric diaphyseal forearm fractures are typically treated using titanium elastic nail system (TENS) nailing. However, there are occasional instances where the primary fracture site refractures after surgery, particularly in diaphyseal forearm fractures involving both bones. Our patient was a 12-year-old boy who had come to our facility with a left forearm radius shaft fracture and ulna shaft plastic deformation. The radius shaft fracture was fixed with TENS nailing, and the ulna shaft plastic deformation was corrected by the three-point bending method. Three months later, the patient came back with a refracture of the radius shaft. TENS nail removal, open reduction, and internal fixation of the radius shaft refracture were done with a plate and screws. Anatomic reduction of forearm fractures, open reduction, and the use of plate fixation enable a more thorough correction of malrotation and restoration of the radial bow, allowing for an early range of motion. Since the TENS nail is not a locking device, there is always some amount of mobility at the fracture site, causing loss of reduction, chances of implant failure, and non-union. So primary plating, especially in cases of forearm fractures, appears to be a better option compared to primary TENS nailing in juvenile patients.