Two recent studies reported good healing rates, acceptable alignment, and reliable functional recovery after treatment of fractures of the distal metaphyseal-diaphyseal junction with FIN (Fig. 2).20,21 Ge et al20 compared FIN to Kirschner-wire fixation for 19 metaphyseal-diaphyseal junction fractures and reported better postoperative alignment, shorter operative times, less blood loss, and faster union with FIN.
The ability to limit the amount of casting or splinting and rapid mobilization are 2 of the potential benefits of FIN in patients with polytrauma or an ipsilateral floating elbow injury (Fig. 4). High union rates and good functional outcomes have been reported.9,12,25
FIN frequently is used for prophylactic stabilization of the humeral shaft at the time of treatment of large benign diaphyseal bone cysts or after pathologic fracture (Fig. 5).26–30 While the tumor may recur, radiographic union of pathologic fractures is the norm.
While the surgical technique is easy to describe, it can be challenging to implement. Intraoperative imaging of the humerus can be challenging, because orthogonal views of the proximal humerus can be difficult to obtain. The anatomy, particularly related to the location of nail insertion, may not be as familiar to the pediatric orthopaedist as the anatomy of other bones where FIN is more commonly used. An understanding of humeral anatomy is of paramount importance because many neurovascular structures lie in close proximity to each of the described nail insertion points. Journeau and Annocaro23 and Gordon and Garg10 have provided detailed descriptions of the surgical technique. Those are summarized here.
Shoulder and elbow stiffness are both common after upper extremity trauma in children.5–7 Temporary splinting or casting should be used for only 1 or 2 weeks after FIN to allow earlier motion and prevent stiffness.
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