For the treatment of fractures the distal radius, open reduction and internal fixation with a volar locking plate is most frequently used in addition to conservative therapy, external fixation, and percutaneous needle puncture.Some new implants, such as bridging plates, intramedullary nails, and wrist prosthesis, have also gained clinical application.In the recent years, some new techniques like wrist arthroscopy, new bone cement, 3D printing, and digital technology have provided more accurate and stable diagnosis and treatment of the disease.In spite of a variety of strategies, the treatment of fractures the distal radius is focused on the restoration and maintenance of the volar tilting angle and the ulnar inclination in the distal radius.Doctors need to consider the injury characteristics and rehabilitation requirements of the patients and choose the simplest and safest methods to achieve optimal outcomes.

Objective:To evaluate the clinical efficacy of intramedullary nailing for femoral shaft fracture in adolescents.Methods:From May 2017 to October 2019, 30 adolescent patients with femoral shaft fracture were treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine. They were 20 males and 10 females, aged from 12 to 17 years (average, 14 years), with 13 left and 17 right sides affected. They were all fixated with intramedullary nailing; open reduction and internal fixation was performed in 12 cases and closed reduction and internal fixation in 18 cases. Recorded were operation time, intraoperative blood loss, and time for postoperative antibiotic use; compared were lower limb length, neck-shaft angle, femoral neck diameter (FND), articular trochanteric distance (ATD) and Harris scores between the healthy and affected sides at the final follow-up.Results:For the 18 patients undergoing closed reduction and 12 patients undergoing open reduction, respectively, the intraoperative blood loss averaged 153.2 mL and 238.0 mL, the operation time 70.5 min and 91.5 min, and the time for antibiotic use 1.5 d and 3.0 d. The 30 patients were followed up for 12 to 41 months (average, 20.3 months). Follow-up revealed no such complications as fracture nonunion, delayed union, malunion, heterotopic ossification of the hip, refracture of the femoral shaft, or developmental deformity of the proximal femur. The lower limb length, neck-shaft angle, FND, ATD and Harris scores at the final follow-up were, respectively, 133.4°±2.3°, (29.3±4.2) mm, (27.1±6.3) mm and 96.4±3.6 for the affected side, insignificantly different from those for the healthy side [132.4°±3.5°, (30.2±3.6) mm, (26.4±6.8) mm and 95.6±4.7] ( P>0.05). Conclusion:Intramedullary nailing is effective for femoral shaft fracture in adolescents, leading to positive efficacy and limited complications and impact on the development of proximal femur.