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    Surgery · Fractures

    Forearm fractures: when ESIN changes the story

    The forearm doesn't just support the hand: it rotates it. That is why, in radius and ulna fractures, alignment matters as much as bone healing.

    A forearm that heals «slightly crooked» by a few degrees can lose half of pronation and supination. That is why significant rotational deviations are not well tolerated.

    The two main routes

    Conservative treatment

    Closed reduction and an above-elbow cast. Works well for mildly displaced or stable fractures and in young children with high remodelling potential. Requires close X-ray follow-up to catch any re-displacement.

    Surgical fixation

    Needed when alignment is unsatisfactory, when the fracture is unstable, or when age no longer allows reliance on remodelling. The most common techniques are radius/ulna ESIN or, in selected cases, plate and screws.

    Typical surgical procedures

    ESIN — elastic intramedullary nailing of radius and/or ulna

    One or two elastic nails are inserted inside the bone through small skin incisions. They stabilise the fracture without opening it and allow earlier movement recovery.

    Both-bone forearm fractures in school-age children and adolescents, unstable or poorly reducible fractures.

    Both bones are often stabilised together. The nails are removed in a planned second operation once healing is complete.

    Percutaneous K-wires

    Percutaneous stabilisation for distal radius fractures close to the wrist.

    When the site is very distal and ESIN is not the most suitable option.

    Plate and screws

    More rigid fixation reserved for selected cases, typically adolescents near skeletal maturity or complex fractures.

    Failure or non-indication of ESIN, multifragmentary fractures, some revisions.

    Watch out for Monteggia lesions

    An ulnar fracture can be associated with malalignment of the radial head at the elbow (Monteggia lesion). Recognising it on time changes the prognosis: a missed Monteggia is a classic problem that shows up later as elbow dysfunction.

    What changes for the child and the family

    • With ESIN, casting time — when needed — is usually shorter than with conservative treatment alone.
    • Return of wrist and elbow motion is generally quicker, but always gradual.
    • A second operation is planned to remove the nails, usually 6-12 months after surgery.
    • X-ray check-ups verify alignment, rotation and healing progression.

    A second opinion on a paediatric fracture

    Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.

    Book a visit

    Content for general informational purposes only. It does not replace a medical evaluation.