ArticleActa orthopaedica2026
Long-term implant retention after impacted elastic stable intramedullary nailing in pediatric diaphyseal forearm fractures: a retrospective cohort study.
Article in Acta orthopaedica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Should we remove flexible intramedullary nails after diaphyseal forearm pediatric fracture? A cohort study of 288 patients.Acta orthopaedica · 2026Article
- A 3-mm protrusion threshold after pediatric forearm ESIN: a rule-out safety margin, not a decision rule.Acta orthopaedica · 2026Article
- Response to Letter: A 3-mm protrusion threshold after pediatric forearm ESIN: a rule-out safety margin, not a decision rule.Acta orthopaedica · 2026Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeIn elastic stable intramedullary nailing (ESIN) for forearm fractures, nail protrusion may cause irritation-related implant removal. The primary aim was to evaluate implant retention after nail impaction, and secondarily to assess secondary procedures, complications, and protrusion as a predictor of removal.
methodsWe analyzed a retrospective cohort of children with diaphyseal forearm fractures treated with impacted ESIN between 2017 and 2024. Implant retention was defined as no nail removal at record review. Secondary procedures were unplanned operations, while complications were adverse events managed conservatively. Radiographic nail protrusion was measured as extraosseous nail length and evaluated using receiver operating characteristic analysis to predict irritation-related implant removal.
results160 children with diaphyseal forearm fractures were included. At a mean observation time of 5 years, 132/160 children retained their implants (83%, 95% confidence interval [CI] 76-88). Secondary procedures occurred in 30/160 patients (19%, CI 13-26), most commonly irritation-related implant removal (10%, CI 6-16) and refracture (6%, CI 3-10). Complications occurred in 19/160 patients (12%, CI 7-18), including superficial radial nerve symptoms (7/160; 4.4%) and irritation without implant removal (6/160; 3.8%). A protrusion threshold of 3.3 mm predicted irritation-related implant removal (AUC 0.79, CI 0.71-0.86; sensitivity 100%, CI 83-100; specificity 55%, CI 49-61). No irritation-related removals occurred below this threshold.
conclusionImpacted ESIN was associated with high long-term implant retention, although secondary procedures and complications occurred in about one-third of the patients. A protrusion threshold of 3 mm was linked to irritation-related removal and may guide implant retention.
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