The effects of radial bowing and complications in intramedullary nail fixation of adult forearm fractures
Ali Çağdaş Yörükoğlu1, Ahmet Fahir Demirkan1, Alp Akman1, Ali Kitiş2, Hande Usta2
1Department of Orthopedics and Traumatology, Medical Faculty of Pamukkale University, Denizli, Turkey
2Department of Physical Therapy and Rehabilitation, Medical Faculty of Pamukkale University, Denizli, Turkey
Keywords: Forearm injuries; fracture fixation; intramedullary; radial bowing; synostosis.
Objectives: This study aims to evaluate the effects of radial bowing changes on fracture healing and functional results in adult forearm intramedullary nail applications and complications of forearm nails that have been discussed rarely in the literature.
Patients and methods: Twenty-three patients -11 with isolated radius and 12 with both radius and ulna fractures- (17 males, 6 females; mean age 38.6 years; range 18 to 69 years) who were operated between September 2009 and August 2014 were included in the study. The effects of radial bowing changes on bone healing rates, time to union, and functional levels of the forearm as well as complications of forearm nails were evaluated.
Results: We observed fracture healing without any complication in 20 patients (86.9%) and nonunion in three patients (13.1%) although six months had passed after the operation. Statistically significant difference was detected between radial bowing change and nonunion (p=0.01). Two patients (8.6%) with AO/OTA Classification (The Arbeitsgemeinschaft für Osteosynthesefragen [AO]/Orthopaedic Trauma Association [OTA] Classification), type B3 forearm double fractures had synostosis. Extensor pollicis longus tendon rupture or impingement was detected in six patients (26.8%) for which nails were applied on radius fracture.
Conclusion: Intramedullary nail application may be an appropriate treatment alternative in forearm fractures with their high healing rates; however, synostosis may arise with its use in wedge fractures (AO/OTA type B3) at the same level. Although radial bowing changes do not have a significant effect on ranges of motion of the forearm, it should be kept in mind that fracture healing may be affected adversely in patients with radial bowing changes of high rates. Complications regarding extensor pollicis longus tendon may develop during intra- or postoperative periods in patients for which a radius nail has been applied.