Elastic nail for forearm fractures

 

Your child is having or have just had an elastic nail procedure to treat a forearm fracture/break

This is also known sometimes as a TENS nail (titanium elastic nail), although the nails are not always titanium. 

Elastic nails are ideal for many fractures in pediatric and adolescent patients, and that is why Mr Wang has chosen this method for fixing your child's fracture. 

Below is an example of a fracture treated with elastic nails

Post operative Recovery

Following surgery, it is normal for there to be some pain experienced in the forearm, wrist, or elbow

It is normal for your child to experience some tingling or numbness in their fingers, as this may be due to the local anaesthesia Mr Wang used to help reduce the pain. 

Time in plaster (3-6 weeks)

  • Although the fracture is fixed with an elastic nail, it still needs to be protected using a plaster for 4-6 weeks

  • During this time you should encourage your child to frequently move their fingers/thumb, as soon as it is comfortable to do so

  • Ask them to stretch their fingers out all the way with the assistance of the other hand, or you may help them with this exercise to stretch their fingers out

  • Then close it all the way into a fist, with the assistance of the other hand or your help if necessary 

  • These finger exercises help keep the fingers from becoming stiff whilst in the plaster

  • Keep your child's arm elevated as much as possible. This is particularly important in the first 5-7 days following surgery. This helps with reducing swelling. Use a pillow to prop their arm up if they are seated or lying down. 

  • You should not let water get into the cast as this may get into the wound or damage the cast. You may use a plastic bag tied over the cast during shower or bathing. 

Following cast/dressing removal

  • This may occur between weeks 3 to 6 following surgery, depending on the fracture pattern and age of your child

  • There may be tails of dissolvable sutures used for skin closure. There may also be 'steristrips' or small wound closure tapes, that could be either removed during the appointment or left to fall off at home/in the shower over the next few days. 

  • After the cast is removed, your child may start moving his/her elbow and wrist. Initially they may not wish to and this is normal, as they have not moved for several weeks and can feel apprehensive. However, they will gradually start moving it in the next few days. 

  • Some discomfort during moving of elbow and wrist at this stage is also normal

  • Despite the elbow and wrist being possibly stiff, usually children do not require physiotherapy as movement is expected to recover. Sometimes Mr Wang will ask your child to see a physiotherapist to help speed up recovery of movement. 

  • It is important at this time that your child continues to abstain from contact sport or high risk activities where they are at increased risk of falling. This is because although the fracture is now strong enough for them to move their arms without a cast, it is not 100% healed yet and is a higher chance of re-fracture should they have an injury

Following bone healing

  • This may occur between 6 weeks and 4 months following surgery, depending on age and the exact break. Sometimes the bones may not heal until even later.

  • Bone healing is usually determined on xray, and Mr Wang will advise you when there is sufficient healing for your child to progress with their activities.

  • Once sufficient bone healing has occurred, your child could then increase weight-bearing of the arm, and gradually return to sports.

  • Physiotherapy, if indicated at this stage, will focus on regaining strength and progression back to sporting activities.

 

Removal of nail

  • Mr Wang will have a discussion with you about the pros and cons of removal of the nail following healing of the fracture. This will usually not happen until at least 3 months following the surgery

  • It is not absolutely necessary to remove the nail. It does not cause blood contamination. The nail is buried inside the bone and should not cause any discomfort or affect growth. It should not set off any metal detectors at airports etc.

  • However, if the nail is not removed within the first year, it can become quite difficult to remove later on. 

  • There is a small chance that even after the fracture has healed 100%, your child may re-injure their arm later in life and therefore sustain a fracture in the same bones again. If that was to occur and the nail is still inside the bone, the procedure to fix that fracture will be more challenging with a broken/bent nail inside the bone. For this reason Mr Wang will have a discussion with you about whether the nail may be removed.

  • If decision is made between Mr Wang and yourself to remove the nail, then this is usually scheduled for between 3 and 12 months following initial surgery. The removal surgery is a day procedure case, and your child may return to all activities 3-4 days following nail removal. 

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for professional medical advice.