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CASE REPORT Table of Contents   
Year : 2005  |  Volume : 39  |  Issue : 2  |  Page : 121-122
Bent forearm nails - A case report

Alka Physiotherapy & Orthopaedic Centre, Bhopal, India

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How to cite this article:
Batra U. Bent forearm nails - A case report . Indian J Orthop 2005;39:121-2

How to cite this URL:
Batra U. Bent forearm nails - A case report . Indian J Orthop [serial online] 2005 [cited 2020 Jan 26];39:121-2. Available from:

   Introduction Top

Open reduction and intramedullary nailing is one of the old procedures for management of fractures of forearm bones in adults. Bending of nails is an occasional complication seen in intramedullary nailing of any bone in the body. We are reporting here a case of bent nails of forearm due to an epileptic seizure in post-operative period.

   Case report Top

A 30 yrs old female reported in May '89 with fractures of both bones of right forearm (midshaft). Intramedullary nailing of both bones was done with Talwalkars Square nails (INOR). Preoperatively a physician examined patient and antiepileptic drugs were given to keep the seizures under control, as she was a known case of epilepsy. Post --operative check X-Ray revealed satisfactory position of the implant as well as the position of the fracture.

About 15days later the lady had a seizure when she developed a 90 0 angulation at the fracture site [Figure - 1]a with bending of nails in situ. There was no neuro vascular deficit distally. Immediately she was taken for closed manipulation under anaesthesia. The fracture was reduced and bent nails were straightened and plaster cast was applied. Subsequently she had full recovery [Figure - 1]b.

After about 9 years she was seen again for some other complaints unrelated to the fracture. Her hand and forearm on the affected side were functionally normal. Last few degrees of supination and pronation were restricted. There was restriction of dorsiflexion of wrist also [Figure - 1]c.

After another 2 years she complained of pain on right radial styloid, at the tip of the nail just near the wrist joint. It was found to be infective bursitis. Since the fracture had united well it was decided to remove nail. An attempt to remove this nail was futile as the nail was jammed into the medullary canal. Therefore the tip of the nail was cut. The inflammatory bursitis subsided. After 14 years the patient has a pain free function of the hand and forearm with nails in situ.

   Discussion Top

Intramedullary nails are made up of cold drawn wires responsible for its toughness and ductility. If metals are strained repeatedly within its plastic range they show reduction in their strength. This plastic bending in a cycle or two should not cause microfractures, or any other deterioration of polished surface of implant, which may also cause corrosion of the implant. This weakening of the implant should never lead to instability at the fracture site otherwise nonunion will occur.

There is paucity of literature about problems associated with bent nails. Hence there is no definite consensus that what should be the protocol in such situations. In general, change of implant is the treatment being recommended.

Closed manipulation of fracture with nail in situ, can be done very easily without exposing the fracture site again. As per studies of material scientists the plastic deformation of an implant leads to reduction in its strength. Therefore it is being recommended that patients who have had the deformation of nail even once, extra precaution should be observed, such as giving an extra cast for a period of at least 6-8 weeks.

Two aspects of management of fractures of forearm bones require attention. One is that the bending of nails due to an epileptic fit needs to be addressed by an appropriate antiepileptic medication. Bracing or a POP cast is required to prevent any re-injury to the fracture site post operatively.

Secondly, most important aspect which should draw the attention of orthopaedic surgeons, is the quality of implant. If the quality of implant is excellent, it can withstand the load and such manipulations are possible. To conclude, I feel that closed manipulation of forearm fractures with nails in situ is a safe procedure, which can be performed without exposing the fracture site again.[1]

   References Top

1.Muensterer OJ, Regauer MP. Closed reduction of forearm refractures with nails in situ. J Bone Joint Surg (Br). 2003; 85: 2152-55.  Back to cited text no. 1    

Correspondence Address:
Umesh Batra
C-8 Housing Board Colony, Kohe-Fiza, Bhopal - 462001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5413.36788

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