To evaluate the efficacy of elastic stable intramedullary nailing (ESIN) for the treatment of forearm fractures in children and adolescents. Between June 2002 and August 2007, 28 patients (19 boys – 9 girls) with 28 forearm fractures were treated with ESIN in our department. The mean age was 12.88 years (range 10.9–4.82). Both forearm bones were affected in all cases. 13 patients were treated by intra-medullary splinting immediate after the accident whilst 15 children were operated after failure of conservative treatment and fracture redisplacement. The radius was nailed in a retrograde fashion in all cases. On the other hand antegrade nailing of the ulna was performed in 18 cases whilst retrograde nailing in 5 patients. In 8 cases closed reduction was possible whilst a small incision at the fracture site was necessary in 20 children. In all cases an above-elbow cast was applied for 5 – 6 weeks postoperatively. The healing process was determined on the basis of two-projection radiographs. At the latest follow-up elbow and forearm motion were also assessed. Mean follow-up was 16 months (range, 7 – 28). With the exception of one case all fractures healed within 9 weeks. No case of infection, cross-union or non-union occurred. At the latest follow-up all children presented with complete restoration of elbow movement but three of them had a deficit of pronation of 15–20 degrees. In those cases where an open reduction was required the results were the same as in other cases. Based on our results, retrograde, of both bones, nailing is recommended for the treatment of all displaced forearm fractures in children older than 7 years-old. Proper preoperative curving of the nails offers increased stability maintaining the anatomic relation of the forearm bones.
From 1970, when Buchholz started incorporating antibiotics in bone cements, until now, many studies have been published supporting the beneficial effects of Palacos R with gentamicin in prevention and therapy of infections in orthopaedic surgery. Despite the continuously increasing rates of genta-micin-resistant strains, the empirical use of gentamicin was reduced only as far as its systemic administration is concerned, while its local use in addition to bone cements has increased. The latter is justified by the gradual release of the antibiotic and its low toxicity. We studied during the period of August 2000 to August 2001, 668 operations which were performed with P-G in 6 orthopaedic clinics of KAT hospital (129 total hip arthroplasties, 258 total knee arthroplasties, 29 hip revisions, 11 knee revisions and 241 hip hemiarthroplasties) and 137 operations with simple cement, out of total 1346 operations. All the above surgeries were performed either in 5 classical operational fields or in 2 controlled ventilation ones. The rate of infection was 1,02% in total, and does not differ from the infection rate of the 3rd orthopaedic department of the same hospital that performs the same operations in the same operating rooms without the usage of P-G, with the exception of revisions that P-G was used. We believe that the high gentamicin-resistant rates of nosocomial microorganisms in combination with the non-complete inhibition of biofilm formation, the negative effect that gentamicin has on bone regeneration and the entailed risk of emergence of resistant organisms to gentamicin because of the continuous and long lasting release of the antibiotic in subtherapeutic concentrations, does not justify the use of Palacos R with gentamicin as prevention of infections. Perhaps the development of other bone-loaded antibiotics, that do not affect the strength of the cement, would be better accepted than gentamicin in the future.
