Abstract: Purpose: The upper limb is an important integral part of body and loss of whole upper limb according to Workman Compensation Act takes away 90% of the earning capacity of an individual. The successful treatment of forearm fractures means that union of fracture is achieved and there is minimum or no restriction of rotations with full movements of wrist and elbow joints. Failure to achieve these will compromise functional results.
Aims & Objectives: The aim of our study is to find the efficacy of closed intramedullary nailing and compare its results with extra-medullary fixation methods.
Material & Methods: A study of 50 patients with minimum follow up of 3 months, out of total 74 patients was carried out in Department of Orthopaedics at tertiary care centre. All the patients were immobilised in form of above elbow plaster of Paris immediately after surgery. This plaster was continued for 4-6 weeks. The criteria for clinical union include no local tenderness over fracture site and attempted supination and pronation are not very painful.
Results & Discussion: The age of patients in the present series is from 13 years to 90 years. 76% patients were below the 50 years of age. About half of these men were labourers by occupation with indirect mode of injury to the non-dominant hand leading to two thirds with closed both bones radius ulna fractures. Out of 46 patients with 79 radius ulna fractures, 40 patients (87%) achieved full elbow & wrist flexion and extension. 10 patients (15%) had severe restriction of prono-supination. 36 patients (88.26%) had excellent to good outcomes while 3 patients (6.53%) had poor outcome due to non-union and infection. Advantages of intramedullary fixation include minimal operating time and no need of intravenous drip for the procedure. Surgery can be done under local or regional anaesthesia. Small incisions are required and only 2-3 stitches for closure. Cosmetically very well accepted scar by all patients (mainly females) which is almost invisible. Infection rate is almost negligible. In this method there is no soft tissue damage, periosteal stripping or neurovascular damage. Clinically as well as radio logically the union time is equivalent (if not less) than extra medullary fixation.
Conclusion: Almost all patients achieved good functional range of movements and returned to pre injury occupation. There were no neurovascular complications. All patients were satisfied from treatment.
