Titanium Elastic Nailing System, An Effective Way of Pediatric Forearm Fracture Management

Document Type : Original Article


1 Assistant professor, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.

2 Senior Resident, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.

3 Junior Consultant, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.

4 Junior Resident, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.

5 professor and Head, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.

6 Senior Resident, Dept of Psychiatry, SHKM GMC Nalhar Nuh, Haryana, India.



Background: Pediatric forearm fractures are commonly encountered in an orthopedic emergency. Treatment varies widely from simple sling and cast to operative fixation with nailing and plating, with no definitive consensus on treatment modality. This study aimed to evaluate the functional outcome of pediatric forearm fractures managed by the titanium elastic nailing system and measure the difficulty.
Methods:  The study was conducted at the department of orthopedics, SHKM Govt medical college Nuh, India, which included 30 patients, 18 males and 12 females from 6 to 15 years (with a mean age of ten years). Twenty patients had middle third fractures, six proximal 1/3rd, and three distal 1/3rd fractures. The transverse fractures were seen in 17, oblique fractures in six, communicated in four, and spiral fractures in three patients.
Results: Overall, 30 patients were included in this study, 18 were Male children, and 12 were females. The Right-sided Forearm was involved in 18 patients (60%), and the Left-sided in 12 patients (40%). Closed bone fractures were noted in 24 patients (80%), open Grade I in 4 patients, and Grade II in 2 patients. The Mean hospital stay was three days, ranging from 2-5 days. The Fracture site showed radiographic healing at six weeks in five patients, at nine weeks in 24 patients, and 12 weeks in all patients. The functional outcome was excellent in 28 patients and good in two patients. No patient showed poor function at the final follow-up (one year). The complications were eight patients with skin irritation at the nail insertion site, two cases who developed signs of infection like erythema and serous discharge, and two patients with ulnar nail back out.
Conclusion: TENS (Titanium Elastic Nailing System) allows micromotion at the fracture site due to the elasticity of the nails elastic deformation within the medullary canal creates a bending moment within the long bone that is not rigid but, that is stable enough to reduce and fix the fracture and favors callous formation and bone healing. The treatment of pediatric bone fractures with TENS continues to be the unparallel success and reliable treatment method with a predictable outcome and minimal complications. We recommend this type of treatment in angulated and unstable forearm fractures in children.