Proximal forearm antegrade elastic stable intramedullary nailing for pediatric distal radius metaphyseal-diaphyseal junction fractures: A modified technique.

Abstract

Distal radius metaphyseal-diaphyseal junction (MDJ) fractures in children are technically demanding, and the optimal fixation strategy remains controversial. The clinical performance of proximal-forearm antegrade elastic stable intramedullary nailing (A-ESIN) was compared with conventional retrograde crossed Kirschner-wire fixation (R-KW). This retrospective study included 79 children treated for distal radius MDJ fractures at [blinded for review] between January 2018 and April 2024, with a minimum follow-up of 12 months. Thirty-eight underwent A-ESIN and 41 received R-KW fixation. Intraoperative variables (operative time, blood loss, fluoroscopic exposures, open-reduction rate), postoperative recovery (time to cast removal, time to implant removal, excellent/good rates of forearm rotation and wrist flexion-extension), radiographic alignment, and complications were analyzed. Compared with R-KW, A-ESIN resulted in lower blood loss (3.8 ± 2.8 mL vs 5.6 ± 4.1 mL; P = 0.024) and a reduced need for open reduction (10.5 % vs 36.6 %; P = 0.007). Casts were removed earlier (25.1 ± 2.0 days vs 39.4 ± 6.9 days; P < 0.001). Excellent/good functional outcomes were more frequent for forearm rotation (92.1 % vs 65.9 %; P = 0.006) and wrist flexion-extension (97.4 % vs 70.7 %; P = 0.003). Radiographic alignment was excellent/good in 84.2 % of A-ESIN cases versus 65.9 % of R-KW cases (P = 0.048). Fewer complications occurred with A-ESIN (one superficial wound infection) than with R-KW (five pin-tract infections, one transient radial-nerve palsy, two redisplacements, and two physeal injuries). Proximal-forearm A-ESIN is a less invasive, more stable technique that expedites functional recovery and lowers complication rates relative to retrograde crossed K-wires. It represents a safe and effective alternative for managing pediatric distal radius MDJ fractures.