Indications and results of flexible intramedullary nailing in forearm shaft and proximal radius fractures and their epidemiology

In a doctoral thesis conducted at the University of Oulu, we observed a significant change in the incidence of fractures among children and adolescents: mid-shaft forearm fractures increased fivefold over a 20-year period (2000–2019). One in three of these fractures resulted from a trampoline injury, and trampoline accidents were the single most common cause of forearm fractures. Surprisingly, the study also revealed a marked increase in the proportion of girls among the patients toward the end of the study period—an unexpected trend, as boys typically sustain more fractures.

Mid-shaft forearm fractures account for less than 10 percent of all pediatric fractures, but they are often severe and difficult to treat, making the dramatic increase particularly concerning. Because mid-shaft forearm fractures are serious injuries, we examined the typical surgical treatment methods and succeeded in developing a way to better determine the most suitable surgical technique for each patient. The study showed that certain findings in a child’s radiograph—associated with specific stages of skeletal maturity—can help surgeons choose the appropriate surgical method. For example, techniques that use very flexible intramedullary nails are suitable for younger children but no longer appropriate for adolescents once they reach a certain stage of bone development.

The dissertation also compared two different surgical techniques for another difficult pediatric fracture: fractures of the proximal radius. At Oulu University Hospital, fractures treated with a newer intramedullary nailing technique healed better than those treated with traditional thin steel pins inserted across the fracture.

Upper-limb fractures are the most common fractures in children and adolescents. In this doctoral research, we identified ways to improve treatment for these injuries, and the findings are particularly beneficial for severely injured patients who require surgery. Fortunately, the majority of pediatric fractures are mild and can be treated with cast immobilization.

The study highlights the need to raise awareness about the risks of trampoline injuries and to continue improving treatment practices for severe fractures in children and adolescents—especially as these injuries appear to be on the rise.