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03 Jul 2024
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Pediatric Distal Radius Fracture - Double-Bend Titanium Elastic Nail

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Clinical Details

Clinical and radiological findings:  A 7-year-old female presented following a fall from a bicycle, resulting in a left forearm injury. Radiographs revealed an off-ended distal radius fracture at the diaphyseal/metaphyseal transition zone, classified as AO/OTA 23-M/2. The ulna demonstrated a distal buckle fracture. This was a closed injury with neurovascular status intact.

Preoperative Plan

Planning remarks:  The preoperative plan involved a closed reduction attempt of the distal radius fracture under fluoroscopic guidance. Given the significant radial translation of the distal radial fragment, the plan included the use of a titanium elastic nail (TEN) for stabilization if closed reduction was insufficient.

Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table, with her left arm placed to the side on an auxiliary table.

Anatomical surgical approach:  A five-millimeter skin incision was made at the distal radial metaphysis, followed by blunt dissection down to the periosteum. An entry point for the nail was created using a four-point trochar. A 2.5 millimeter titanium elastic nail, pre-bent at its distal end, was introduced into the medullary canal. The nail was advanced proximally across the fracture site, achieving three-point fixation and facilitating dynamic reduction.

Operative remarks: 

The reduction was confirmed in two planes using fluoroscopy. The elastic nail was trimmed within the subcutaneous tissue, and the wound was irrigated and closed with interrupted 4-0 nylon sutures. A below-the-elbow fiberglass splint was applied to immobilize the forearm.

Postoperative protocol:   Not specified

Follow up:   Not specified

Orthopaedic implants used:   2.5mm Titanium Elastic Nail

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Dr Ed Oates

  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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