Published: 2019-02-22

Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

Divyanshu Goyal, S. L. Sharma, Laxmikant Meena, Ravindra Lamoria, Mahesh Bansal


Background: A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.

Methods: We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year.  

Results: In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.

Conclusions: We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.


TENS, Forearm fracture, Adolescent forearm fracture, Adolescent diaphyseal fracture

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Cheng JC, Ng BK, Ying SY, Lam PK. A 10-year study of the changes in the pattern and treatment of 6493 fractures. J Paediatr Orthop. 1999;19(3):344–50.

Creasman C, Zaleske DJ, Ehrlich MG. Analyzing forearm fractures in children: the more subtle signs of impending problems. Clin Orthop Relat Res. 1984;188:40–53.

Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res. 1979;139:114-20.

Fuller DJ, McCullough CJ. Malunited fracture of the forearm in children. J Bone Joint Surg Br. 1982;64:364-7.

Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of paediatric both bone forearm fractures: a comparision of operative techniques. J Pediatr Orthop. 2005;25:309-13.

Shoemaker S, Comstock C, Mubarak S, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Paediatr Orthop. 1999;19:329–37.

Calder PR, Achan P, Barry M. Diaphyseal forearm fractures in children treated with intramedullary fixation: outcome of K-wires versus elastic stable intramedullary nail. Injury. 2003;34(1):278–82.

Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both bone forearm fractures in older children. J Pediatr Orthop. 2008;28:403-9.

Shah AS, Lesnaik BP, Wolter TD, Caird MS, Farley FA, Vander KL. Stabilization of adolescent both bone forearm fractures: a comparision of intramedullary nailing versus open reduction and internal fixation. J Ortop trauma. 2010;24:440-7.

Flynn JM, Jones KJ Garner MR, Geobel J. Eleven years’ experience in the operative management of paediatric forearm fractures. J Pediatr Orthop. 2010;30:313-9.

Price CT. Acceptable alignment of forearm fractures in children: open reduction indications. J Pediatr Orthop. 2010;30:82-4.

Zionts LE, Zalavras CG, Gerhardt MB. Closed treatment of displaced diaphyseal both-bone forearm fractures in older children and adolescents. J Pediatr Orthop. 2005;25:507-12.

Franklin CC, Robinson J, Noonan K, Flynn JM. Evidence-based medicine: management of pediatric forearm fractures. J Pediatr Orthop. 2012;32:S131-4.

Sinikumpu JJ, Pokka T, Serlo W. The changing pattern of pediatric both-bone forearm shaft fractures among 86,000 children from 1997 to 2009. Eur J Pediatr Surg. 2013;23:289-96.

Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6:146-56.

Holmes JH, Wiebe DJ, Tataria M, Mattix KD, Mooney DP, Scaife ER, et al. The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. J Trauma. 2005;59:1309-13.

Kay S, Smith C, Oppenheim WL. Both bone midshaft forearm fracture in children. J Pediatr Orthop. 1986;6:306-10.

Kim WY, Zenios M, Kumar A, Abdulkadir U. The removal of forearm plates in children. Injury. 2005;36:1427-30.

Vopat B, Kane P, Fitzgibbons P, Got CJ, Katarincic JA. Complications associated with retained implants after plate fixation of the pediatric forearm. J Orthop Trauma. 2014;28:360-4.

Vainiopaa S, Bostman O, Patiala H, Rokkanen P. Internal fixation of forearm fractures in children. Acta Orthop Scand. 1987;58:121-3.

Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26:827–34.

Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Trauma. 2008;65:109–15.

Cullen MC, Roy DR, Giza E. Complications of intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop. 1998;18:14–21.

Ogonda L, Wong-Chung J, Wray R, Canavan B. Delayed union and nonunion of the ulna following intramedullary nailing in children. J Pediatr Orthop B. 2004;13:330–3.

Jubel A, Andermahr J, Isenberg J. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop B. 2005;14:375–80.

Schmittenbecher PP, Peter P, Fitze G, Kraus R, Schneidmüller D. Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop. 2008;28:303–6.

Amit Y, Salai M, Chechik A, Blankstein A, Horoszowski H. Closing intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence: a preliminary report. J Pediatr Orthop. 1985;5:143-6.

Kang SN, Mangwani J, Ramachandran M, Paterson JM, Barry M. Elastic intramedullary nailing of paediatric fractures of the forearm: a decade of experience in a teaching hospital in the United Kingdom. J Bone Joint Surg Br. 2011;93:262–5.

Kruppa C, Bunge P, Schildhauer TA, Dudda M. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: A retrospective study of 202 cases. Medicine. 2017;96(16).

Schoenecker, Perry L, Keeler, Kathryn A, Dobbs, Matthew B, et al. Eric. Titanium elastic nailing radius and ulna fractures in adolescents. J Pediatr Orthop. 2012;482–8.

Martus, Jeffrey E, Preston, Ryan K, Schoenecker, Jonathan G, Lovejoy, Steven A, Green, Neil E, Mencio, Gregory A. Complications and Outcomes of Diaphyseal Forearm FractureIntramedullary Nailing: A Comparison of Pediatric and Adolescent Age Groups. J Pediatr Orthop. 2013;33:598–607.