Posteromedial elastic stable intra-medullary nailing (ESIN) in volarly displaced metaphyso-diaphyseal distal radius fractures in child

Introduction: The distal metaphyso-diaphyseal fractures of the radius with volar angulation are generally considered unstable. Too distal to be treated with classic elastic stable intramedullary nailing (ESIN) via a laterodistal approach and too proximal to be stabilized with simple conservative treatment, they are sometimes treated by plating. Patients and methods: To avoid the disadvantages of the open exposure necessary for this latter fixation and to prevent volar angulation while respecting the curvature of the radius, radial elastic nailing with posteromedial distal entry was used in 16 patients. These patients were reviewed with an average follow-up of 4.5 months. Results: Six patients presented a mean volar angulation of 7 degrees, eight a mean posterior angulation of 5.5 degrees, and two were aligned at 0 degrees. On the AP view, seven patients presented a mean residual varus of 6.5 degrees, four a mean residual valgus of 5 degrees, and five were at 0 degrees. The pronating curvature of the radius and the radioulnar index remained intact in all cases. One case of extensor digitorum tenosynovitis was observed and disappeared after wire removal. Discussion: For the unstable fractures of the distal third of the radius, certain authors propose systematic classic ESIN, but the lateral point of entry inevitably entails a varus misalignment, which is no longer the case if the entry is medial.