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Pediatric Forearm Fracture IM Nailing 25575

 
CPT Coding Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:radius and ulna shaft fracture ORIF, forearm fracture ORIF

 Pediatric Forearm Fracture IM Nailing CPT

Pediatric Forearm Fracture IM Nailing Indications

  • refractures with displacement
  • open fx
  • displaced proximal forearm fx
  • unstable fx
  • unacceptable alignment following CR
  • polytrauma

 Pediatric Forearm Fracture IM Nailing Contraindications

  •  

Pediatric Forearm Fracture IM Nailing Alternatives

  • ORIF with plate and screws
  • Closed reduction and casting

Pediatric Forearm Fracture IM Nailing Pre-op Planning

  • Ensure appropriate flexible nails are available

Pediatric Forearm Fracture IM Nailing Technique

  • Lascombes P JPO 1990;10:167-171 , (Kapoor V, Injury 2005;36:1221).
  • Use small Rush rod, Steinmann pin(0.062 in), or elastic titanium nail. 
  • tourniquet, pre-op antibiotics, c-arm
  • 2-cm incision over dorsoradial aspecdt of distal radial metaphysis.
  • Preserve superficial branch of radial nerve.
  • Incise periosteum proximal to the distal radial physis
  • Drill 3.2mm entry point
  • Prebend nail for the curved shape of the radius. Generaly 2-2.5mm nail.
  • Reduce Fracture.
  • Advance nail retrograde up into proximal radius within 1cm of proximal radial physis.
  • Cut nail and advance slightly
  • 1 cm incision over dorsal proximal ulna just lateral to the tip of the olecranon. 
  • Drill 3.2mm entry point
  • Place nail in antegrade fashion, cut and advance slightly.
  • Irrigate wounds
  • Close in layers.
  • Anterior and posterior plaster splints
  • If unable to pass nails in 1-2 attempts open reduction is indicated.  Multiple failed attempts at closed pinning increased risk of compartment syndrome

Pediatric Forearm Fracture IM Nailing Complications

Pediatric Forearm Fracture IM Nailing Follow-up care

  • Post-op: place in volar and dorsal splint.  Elevation.
  • 7-10 Days: wound check, xrays.  Place in short arm cast
  • 3 Weeks:
  • 6 Weeks:xray, assess fracture healing.  If healed discontinue cast.
  • 2 Months:
  • 3 Months:
  • 6 Months:
  • 1Yr:

Pediatric Forearm Fracture IM Nailing Outcomes

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Pediatric Forearm Fracture IM Nailing Review References

  • Huber RI, et al.: Flexible intramedullary nailing as fracture treatment in children. JPO, 1996;16:602-605.
  • Flynn ICL 2002 51:355-60
  • Flynn ICL 52:635-45
  • CORR 402-245