{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:01:11Z","timestamp":1789412471284,"version":"build-2803163510"},"reference-count":16,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0In 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.Methods:\u00a0We 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.Results:\u00a0160 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\u201388). Secondary procedures occurred in 30\/160 patients (19%, CI 13\u201326), most commonly irritation-related implant removal (10%, CI 6\u201316) and refracture (6%, CI 3\u201310). Complications occurred in 19\/160 patients (12%, CI 7\u201318), 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\u20130.86; sensitivity 100%, CI 83\u2013100; specificity 55%, CI 49\u201361). No irritation-related removals occurred below this threshold.Conclusion:\u00a0Impacted 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.<\/jats:p>","DOI":"10.2340\/17453674.2026.45693","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T19:26:58Z","timestamp":1775071618000},"source":"Crossref","is-referenced-by-count":3,"title":["Long-term implant retention after impacted elastic stable intramedullary nailing in pediatric diaphyseal forearm fractures: a retrospective cohort study"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9266-129X","authenticated-orcid":false,"given":"Jan Egil","family":"Brattgjerd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christer","family":"Aasheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Rosenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoffer","family":"Fotland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Halvorsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"147896","doi-asserted-by":"crossref","unstructured":"Reddy E, Sriwastwa A, Patel S, Gupta R, Parikh S N. Elastic stable intramedullary nailing for pediatric forearm fractures: a review article. J Clin Orthop Trauma 2025; 71: 103249. doi: 10.1016\/j.jcot.2025.103249.","DOI":"10.1016\/j.jcot.2025.103249"},{"key":"147897","doi-asserted-by":"crossref","unstructured":"Hunt A, Judkins N, Biggs A, Sedgwick P, Hing C B, Yeo A. The use of flexible nails in the treatment of paediatric long bone fractures: experience at a level one paediatric trauma centre, a cohort study. J Clin Orthop Trauma 2024; 49:102355. doi: 10.1016\/j.jcot.2024.102355.","DOI":"10.1016\/j.jcot.2024.102355"},{"key":"147898","doi-asserted-by":"crossref","unstructured":"Poutoglidou F, Metaxiotis D, Kazas C, Alvanos D, Mpeletsiotis A. Complications of elastic stable intramedullary nailing in pediatric forearm fractures, a systematic review. J Orthop 2020; 20: 125-130. doi: 10.1016\/j.jor.2020.01.002.","DOI":"10.1016\/j.jor.2020.01.002"},{"key":"147899","doi-asserted-by":"crossref","unstructured":"Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 2006; 26(6): 827-34. doi: 10.1097\/01.bpo.0000235397.64783.d6.","DOI":"10.1097\/01.bpo.0000235397.64783.d6"},{"key":"147900","doi-asserted-by":"crossref","unstructured":"Nisar A, Bhosale A, Madan S S, Flowers M J, Fernandes J A, Jones S. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures. J Orthop 2013; 10(1): 17-24. doi: 10.1016\/j.jor.2013.01.003.","DOI":"10.1016\/j.jor.2013.01.003"},{"key":"147901","doi-asserted-by":"crossref","unstructured":"Ligier J N, Metaizeau J P, Pr\u00e9vot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br 1988; 70(1): 74-7. doi: 10.1302\/0301-620X.70B1.3339064.","DOI":"10.1302\/0301-620X.70B1.3339064"},{"key":"147902","doi-asserted-by":"crossref","unstructured":"Peterson H A. Metallic implant removal in children. J Pediatr Orthop 2005; 25(1): 107-15. doi: 10.1097\/00004694-200501000-00024.","DOI":"10.1097\/00004694-200501000-00024"},{"key":"147903","doi-asserted-by":"crossref","unstructured":"Busam M L, Esther R J, Obremskey W T. Hardware removal: indications and expectations. J Am Acad Orthop Surg 2006; 14(2): 113-20. doi: 10.5435\/00124635-200602000-00006.","DOI":"10.5435\/00124635-200602000-00006"},{"key":"147904","doi-asserted-by":"crossref","unstructured":"Simanovsky N, Tair M A, Simanovsky N, Porat S. Removal of flexible titanium nails in children. J Pediatr Orthop 2006; 26(2): 188-92. doi: 10.1097\/01.bpo.0000218534.51609.aa.","DOI":"10.1097\/01.bpo.0000218534.51609.aa"},{"key":"147905","doi-asserted-by":"crossref","unstructured":"Fernandez F F, Langend\u00f6rfer M, Wirth T, Eberhardt O. Failures and complications in intramedullary nailing of children\u2019s forearm fractures. J Child Orthop 2010; 4(2): 159-67. doi: 10.1007\/s11832-010-0245-y.","DOI":"10.1007\/s11832-010-0245-y"},{"key":"147906","doi-asserted-by":"crossref","unstructured":"Narayanan U G, Hyman J E, Wainwright A M, Rang M, Alman B A. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop 2004; 24(4): 363-9. doi: 10.1097\/00004694-200407000-00004.","DOI":"10.1097\/01241398-200407000-00004"},{"key":"147907","doi-asserted-by":"crossref","unstructured":"Morshed S, Humphrey M, Corrales L A, Millett M, Hoffinger S A. Retention of flexible intramedullary nails following treatment of pediatric femur fractures. Arch Orthop Trauma Surg 2007; 127(7): 509-14. doi: 10.1007\/s00402-007-0286-y.","DOI":"10.1007\/s00402-007-0286-y"},{"key":"147908","doi-asserted-by":"crossref","unstructured":"Lyman A, Wenger D, Landin L. Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications. J Pediatr Orthop B 2016; 25(5): 439-46. doi: 10.1097\/BPB.0000000000000278.","DOI":"10.1097\/BPB.0000000000000278"},{"key":"147909","doi-asserted-by":"crossref","unstructured":"von Elm E, Altman D G, Egger M, Pocock S J, G\u00f8tzsche P C, Vandenbroucke J P; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. 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