Comparative Analysis of Clinical and Functional Outcomes

Intramedullary Kirschner-wire Versus Elastic Stable Intramedullary Nailing for Pediatric Diaphyseal Forearm Fractures

Abstract

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