Herdea Alexandru, Dragomirescu Mihai-Codrut, Tiron Mara, Ulici Alexandru
11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, Bucharest, Romania.
J Child Orthop. 2025 Jul 19:18632521251352323. doi: 10.1177/18632521251352323.
Elastic stable intramedullary nailing is widely recognized for treating pediatric forearm fractures due to its stable fixation and minimal impact on soft tissue. Traditionally, casting has followed elastic stable intramedullary nailing; however, recent studies question its necessity. This study evaluates the outcomes of omitting casts post-elastic stable intramedullary nailing, examining healing speed and quality of life compared to cases where casting was applied.
A prospective study was conducted from 2022 to 2024 in an urban hospital, where children with both-bone midshaft forearm fracture were randomized to receive or not receive casting after elastic stable intramedullary nailing. Age- and sex-matched patients were selected to allow for accurate comparison. The study included patients aged 5 to 14 years. Outcomes were measured using radiographic scores and quality-of-life assessments.
From a total of 355 patients, 136 cases were included in the assessment. Analysis indicated faster healing in patients without postoperative casting, as evidenced by higher REBORNE scores at 3 weeks and 2 months. Quality of life, measured by the Pediatric Quality of Life Inventory, was also significantly improved in the no-cast group at 6 weeks.
Our findings suggest that elastic stable intramedullary nailing provides sufficient stability for both-bone midshaft forearm fracture, making additional casting unnecessary. Early mobilization led to better functional outcomes without increasing complications. Although some minor early discomfort was reported, the cast-free approach proved effective and safe.
Elastic stable intramedullary nailing remains the gold standard for treating pediatric forearm fractures. Our preliminary results indicate that for both-bone midshaft forearm fracture, elastic stable intramedullary nailing can be safely performed without postoperative casting, promoting faster healing and better patient satisfaction.
弹性稳定髓内钉因固定稳定且对软组织影响极小，在治疗儿童前臂骨折方面得到广泛认可。传统上，弹性稳定髓内钉术后会进行石膏固定；然而，近期研究对其必要性提出质疑。本研究评估弹性稳定髓内钉术后不使用石膏的效果，对比使用石膏的病例，考察愈合速度和生活质量。
2022年至2024年在一家城市医院进行了一项前瞻性研究，将双侧骨干中段前臂骨折的儿童随机分为弹性稳定髓内钉术后接受或不接受石膏固定两组。选择年龄和性别匹配的患者以进行准确比较。研究纳入了5至14岁的患者。通过影像学评分和生活质量评估来衡量结果。
在总共355例患者中，136例纳入评估。分析表明，术后未使用石膏的患者愈合更快，3周和2个月时的REBORNE评分更高即为证明。通过儿童生活质量量表测量的生活质量，在无石膏组6周时也有显著改善。
我们的研究结果表明，弹性稳定髓内钉为双侧骨干中段前臂骨折提供了足够的稳定性，无需额外石膏固定。早期活动带来了更好的功能结果，且未增加并发症。尽管报告了一些轻微的早期不适，但无石膏方法被证明是有效且安全的。
弹性稳定髓内钉仍然是治疗儿童前臂骨折的金标准。我们的初步结果表明，对于双侧骨干中段前臂骨折，弹性稳定髓内钉术后无需石膏固定即可安全进行，能促进更快愈合并提高患者满意度。
