University of Oulu

Perhomaa, M., Kyrö, A., Niinimäki, J., & Sinikumpu, J.-J. (2022). Retrograde intramedullary nailing of the radius in children: A pilot magnetic resonance imaging study of soft-tissue findings. Journal of Children’s Orthopaedics, 16(4), 269–275.

Retrograde intramedullary nailing of the radius in children : a pilot magnetic resonance imaging study of soft-tissue findings

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Author: Perhomaa, Marja1,2; Kyrö, Antti3; Niinimäki, Jaakko2;
Organizations: 1Oulu Childhood Fracture and Sports Injury Study, Division of Pediatric Surgery and Orthopedics, Department of Children and Adolescents, PEDEGO Research Group, Medical Research Center (MRC) Oulu, Oulu University Hospital and Oulu University, Oulu, Finland
2Department of Pediatric Radiology, Medical Imaging, Physics and Technology (MIPT), Oulu University Hospital and Oulu University, Oulu, Finland
3Department of Children, Pediatric Surgery, Päijät-Häme Central Hospital, Lahti, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: British Editorial Society of Bone & Joint Surgery, 2022
Publish Date: 2023-03-08


Purpose: Unstable forearm shaft fractures in children are preferably treated surgically using elastic stable intramedullary nails. The radius is nailed retrograde from the distal metaphysis. There is a risk of surgery-related soft-tissue complications during the operation. Close evaluation of occult surgery-related soft-tissue lesions has not been possible previously, due to the titanium alloy hardware used in the process. The aim of the present study was to evaluate the potential findings in the surrounding soft tissues after intramedullary nailing of the radius, by using magnetic resonance imaging.

Methods: The study population comprised 15 pediatric patients with forearm shaft fractures treated by polylactide-co-glycolide biodegradable intramedullary nails and postoperatively evaluated via magnetic resonance imaging. The main outcome was signal abnormality in any tendon at the entry point postoperatively. Secondarily, other changes in the soft tissues related to nailing were determined. Furthermore, the precise location of the entry point and the anatomic characteristics of the soft-tissue tunnel were described.

Results: In total, 5 of 15 patients (33.3%) had transient signal pathology in a tendon postoperatively. Edema around the superficial radial nerve was detected in 13 of 15 patients (86.7%). The most common surgical approach was between the extensor pollicis brevis and the extensor carpi radialis longus tendons, which was applied in 10 of 15 patients (66.7%).

Conclusions: One in three patients exhibited transient and occult surgery-related intraparenchymal signal pathology in a tendon, after forearm intramedullary nailing. Caution with surgical prepare of the soft-tissue cleavage is recommended.

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Series: Journal of children's orthopaedics
ISSN: 1863-2521
ISSN-E: 1863-2548
ISSN-L: 1863-2521
Volume: 16
Issue: 4
Pages: 269 - 275
DOI: 10.1177/18632521221114553
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s) 2022. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons AttributionNonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (