Comparative Analysis of Clinical and Functional Outcomes: Intramedullary Kirschner-wire Versus Elastic Stable Intramedullary Nailing for Pediatric Diaphyseal Forearm Fractures

Ali Glaisa; Ali  Zaggout; Hussien Alhalloup; Alhadi Alsaghaier; Mustafa Alsagier

المؤلفون

Ali Glaisa Orthopedic Surgeon and Lecturer Misurata University School of Medicine Misurata Libya
Ali Zaggout Orthopedic Surgeon and Lecturer Misurata University School of Medicine Misurata Libya
Hussien Alhalloup Orthopedic Surgeon and Lecturer Misurata University School of Medicine Misurata Libya
Alhadi Alsaghaier Orthopedic Surgeon and Lecturer Misurata University School of Medicine Misurata Libya
Mustafa Alsagier Consultant Orthopedic Surgeon and Assistant Professor Misurata University Misurata Libya

الكلمات المفتاحية:

Forearm fractures، Pediatric surgery، Kirschner-wire، Elastic Stable Intramedullary Nailing, Nancy nail، Price criteria

الملخص

Background: Elastic Stable Intramedullary Nailing (ESIN) using Nancy nails is the preferred treatment for pediatric diaphyseal forearm fractures failing conservative management. However, specialized implants can be costly and unavailable in resource-limited settings, prompting surgeons to use Kirschner-wires (K-wires) as an alternative.

Materials and Methods: A randomized trial was conducted over a one-year period at Misurata Central Hospital and Aljazeera Hospital, involving 32 pediatric patients (aged 5–12 years) with unstable diaphyseal both-bone forearm fractures. Patients were allocated to receive either intramedullary K-wire fixation ($n=17$) or elastic Nancy nail fixation ($n=15$). Functional and clinical outcomes were evaluated at six months postoperatively using the Price et al. criteria.

Results: Bony union was achieved in 100% of patients in both groups within 12 to 14 weeks. According to the Price et al. criteria, an 'Excellent' or 'Good' functional outcome was achieved by all patients, with 88.2% in the K-wire group and 86.7% in the Nancy nail group scoring 'Excellent'. Surgical duration, immobilization period, and time to implant removal were comparable. Complications were limited to minor, transient superficial skin irritation (11.8% for K-wires vs. 6.7% for Nancy nails) which resolved with conservative care. No deep infections or implant failures occurred.

Conclusion: Intramedullary K-wire fixation yields clinical and functional outcomes fully comparable to specialized elastic Nancy nails. Given their widespread availability and cost-effectiveness, carefully pre-bent K-wires serve as a highly reliable primary surgical treatment option, especially in resource-constrained healthcare settings

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