University of Oulu

Linda Korhonen, Marja Perhomaa, Antti Kyrö, Tytti Pokka, Willy Serlo, Juhani Merikanto, Juha-Jaakko Sinikumpu, Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up, Biomaterials, Volume 185, 2018, Pages 383-392, ISSN 0142-9612,

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails : results of a prospective randomized trial in children with at least two years of follow-up

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Author: Korhonen, Linda1; Perhomaa, Marja2; Kyrö, Antti3;
Organizations: 1Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Medical Research Centre Oulu and PEDEGO Research Group, Oulu University, Oulu, Finland
2Department of Radiology, Pediatric Radiology, Oulu University Hospital, Finland
3Department of Orthopedics, Päijät-Häme Central Hospital, Lahti, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 2.5 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2020-09-11


There are disadvantages in Elastic Stable Intramedullary Nailing (ESIN) of forearm-shaft fractures, such as the need of implant removal. Biodegradable Intramedullary Nailing (BIN) is a new technique developed for these fractures. We hypothesized that there is no difference in rotational ROM between the patients treated by BIN vs. ESIN.

A randomized, controlled clinical trial included patients, aged 5–15 years, requiring surgery for forearm-shaft fractures. Biodegradable polylactide-co-glycolide (PLGA) nails (Activa IM-Nail™, Bioretec Ltd., Finland) were used in 19 and titanium nails (TEN®, SynthesDePuy Ltd., USA) in 16 patients. Rotational ROM of forearm after two years was the primary outcome. Elbow and wrist ROM, pain and radiographic bone healing were secondary outcomes.

Forearm rotation was mean 162° and 151° in BIN and ESIN groups, respectively (P = 0.201). No difference between the groups was found in any other ROMs. Three cases in the ESIN vs. none in the BIN group reported pain (P = 0.113). There was no clinically significant residual angulation in radiographs. Two adolescents in the BIN group vs. none in the ESIN (P = 0.245) were excluded because of implant failure; another two with complete bone union suffered from re-injury. Therefore, satisfactory implant stability among older children needs to be studied.

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Series: Biomaterials
ISSN: 0142-9612
ISSN-E: 1878-5905
ISSN-L: 0142-9612
Volume: 185
Pages: 383 - 392
DOI: 10.1016/j.biomaterials.2018.09.011
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
Funding: We are thankful to Mrs. Anna-Maija Haltia, M.Sc., and Mrs. Minna Veiranto, M.Sc., employed by Bioretec Ltd. Finland, that provided the implants for this study. We also thank The Finnish Paediatric Orthopaedics Society, the Vaasa Foundation of Physicians, The Finnish Society of Paediatric Surgeons, The Finnish Foundation of Paediatric Research and The Alma and K. A. Snellman Foundation for supporting the study.
Copyright information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license